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St�phanie Baggio
Life course and social inequality research Centre 
University of Lausanne

Pr. Peter R. Martin, editor-in-Chief
Journal of Addictive Behaviors, Therapy & Rehabilitation
Lausanne, August 18th 2014

Concern: Submission of our manuscript, �The identification of pathological video game use. Comparison of monothetic and polythetic formats�, to Journal of Addictive Behaviors, Therapy & Rehabilitation.

Dear Pr. Martin,

We are pleased to submit the manuscript entitled �The identification of pathological video games use. Comparison of monothetic and polythetic formats� as an original paper to Journal of Addictive Behaviors, Therapy & Rehabilitation. The main purpose of this study was to compare two classifications for defining pathological gaming: the polythetic format and monothetic format.

We declare that all co-authors have read, approve of, and concur with the submitted manuscript, and that all authors have made substantial contributions that meet the stated requirements for authorship. We also declare that due care has been exercised by the authors to ensure the integrity of the work, and that none of the original material contained in the manuscript has been previously published nor is currently under review for publication elsewhere. We declare that nobody of the authors has any conflict of interest. We also declare to have followed the Helsinki declaration and that the study got ethical approval by the Ethics Committee for Clinical Research of the Lausanne University Medical School. 

We would appreciate your considering this paper for publication in Journal of Addictive Behaviors, Therapy & Rehabilitation. We stay at your disposal for any questions or remarks.

Sincerely,


St�phanie Baggio


Pathological video game use. How can we distinguish between pathological, excessive and normal gaming?
Short tittle: Pathological video game use
St�phanie Baggio1,2, Joseph Studer2, Marc Dupuis1, Meichun Mohler-Kuo3, Jean-Bernard Daeppen2, Gerhard Gmel2,4,5,6

1 University of Lausanne, Geopolis building, CH-1015 Lausanne, Switzerland,  HYPERLINK "mailto:Stephanie.baggio@unil.ch" stephanie.baggio@unil.ch, marc.dupuis@unil.ch.
2 Alcohol Treatment Center, Lausanne University Hospital CHUV, Av. Beaumont 21 bis, Pavillon 2, CH - 1011 Lausanne, Switzerland,  HYPERLINK "mailto:Joseph.Studer@chuv.ch" Joseph.Studer@chuv.ch,  HYPERLINK "mailto:Jean-Bernard.Daeppen@chuv.ch" Jean-Bernard.Daeppen@chuv.ch,  HYPERLINK "mailto:Gerhard.Gmel@chuv.ch" Gerhard.Gmel@chuv.ch.
3 Institute of Social- and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland,  HYPERLINK "mailto:meichun.mohler-kuo@uzh.ch" meichun.mohler-kuo@uzh.ch
4 Swiss Institute for the Prevention of Alcohol and Drug Problems, Case postale 870, CH - 1001 Lausanne, Switzerland 
5 Center for Addiction and Mental Health, 250 College St, Toronto, Ontario, M5T 1R8, Canada 
6 University of the West of England, Frenchay Campus Coldharbour Lane, Bristol BS16 1QY, United Kingdom

Corresponding author: St�phanie Baggio, stephanie.baggio@unil.ch, University of Lausanne, Geopolis building, CH-1015 Lausanne, Switzerland, +41�21�692�37�11.

Fundings: Swiss National Science Foundation FN 33CS30_139467.


Abstract
There is no agreement about the distinction between pathological, excessive and normal gaming. The present study compared two classifications for defining pathological gaming: the polythetic format (gamers who met at least half of the criteria) and monothetic format (gamers who met all criteria). Associations with mental, health and social issues were examined to assess differences between subgroups of gamers. A representative sample of 5,663 young Swiss men filled in a questionnaire as part of the ongoing Cohort Study on Substance Use Risk Factors (C-SURF). Game use was assessed with the Game Addiction Scale. Mental, social and physical factors (depression, anxiety, aggressiveness, physical and mental health, social and health consequences), gambling and substance use (illicit drug use, alcohol dependence and problematic cannabis use) were also assessed. The results indicated that monothetic gamers shared problems with polythetic gamers, but were even more inclined to mental health issues (depression, anxiety, and aggressiveness) and were more vulnerable to other dependencies like substance use, alcohol dependence or gambling. A second analysis using Latent Class Analysis confirmed the distinction between monothetic and polythetic gamers. These findings support the use of a monothetic format to diagnose pathological gaming and to differentiate it from excessive gaming.

Key words: Monothetic; Online and offline gaming; Pathological use; Polythetic.
Introduction
Recently, many studies have focused on assessing the pathological potential of gaming  HYPERLINK \l "_ENREF_1" \o "van Rooij, 2010 #39"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 1-4. Over the last few decades, computer use access has exploded. Although these advances connect people wherever they live and provide lots of recreational activities, gaming also has negative effects on physical and mental health  HYPERLINK \l "_ENREF_5" \o "Arnesen, 2010 #281"  ADDIN EN.CITE <EndNote><Cite><Author>Arnesen</Author><Year>2010</Year><RecNum>281</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>281</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">281</key></foreign-keys><ref-type name="Thesis">32</ref-type><contributors><authors><author>Arnesen, Anette Addington</author></authors></contributors><titles><title>Video Game Addiction among Young Adults in Norway: Prevalence and Health</title></titles><dates><year>2010</year><pub-dates><date>2010</date></pub-dates></dates><pub-location>Norway</pub-location><publisher>University of Bergen</publisher><urls></urls></record></Cite></EndNote>5. However, pathological gaming is not yet considered an officially diagnosable disease and little guidance is available to distinguish between excessive and pathological gaming  HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47"  ADDIN EN.CITE <EndNote><Cite><Author>Charlton</Author><Year>2007</Year><RecNum>47</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>47</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">47</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Charlton, J.</author><author>Danforth, I.</author></authors></contributors><titles><title>Distinguishing addiction and high engagement in the context of online game playing</title><secondary-title>Computers in Human Behavior</secondary-title></titles><periodical><full-title>Computers in Human Behavior</full-title></periodical><pages>1531-1548</pages><volume>23</volume><number>3</number><keywords><keyword>Addiction</keyword><keyword>massively_multiplayer_online_games</keyword><keyword>methodology</keyword><keyword>online</keyword><keyword>videogames</keyword></keywords><dates><year>2007</year><pub-dates><date>2007/05//</date></pub-dates></dates><isbn>07475632</isbn><urls><related-urls><url>http://dx.doi.org/10.1016/j.chb.2005.07.002</url></related-urls></urls><electronic-resource-num>10.1016/j.chb.2005.07.002</electronic-resource-num><remote-database-provider>CiteULike</remote-database-provider><access-date>2012/08/20/12:16:36</access-date></record></Cite></EndNote>6. Indeed, �internet gaming disorder� has not been included in the DSM-5 as a formal disorder, and no threshold for classification has been provided  HYPERLINK \l "_ENREF_7" \o "Petry, 2013 #1"  ADDIN EN.CITE <EndNote><Cite><Author>Petry</Author><Year>2013</Year><RecNum>1</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="rtdtvtea49d05veazsbvdtfx02svvfsf00v9" timestamp="1408351155">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Petry, Nancy M.</author><author>O&apos;Brien, Charles P.</author></authors></contributors><titles><title>Internet gaming disorder and the DSM-5</title><secondary-title>Addiction</secondary-title><alt-title>Addiction</alt-title></titles><periodical><full-title>Addiction</full-title><abbr-1>Addiction</abbr-1></periodical><alt-periodical><full-title>Addiction</full-title><abbr-1>Addiction</abbr-1></alt-periodical><pages>1186-1187</pages><volume>108</volume><number>7</number><keywords><keyword>Addiction</keyword><keyword>DSM-5</keyword><keyword>internet gaming</keyword></keywords><dates><year>2013</year><pub-dates><date>2013/07/01/</date></pub-dates></dates><isbn>1360-0443</isbn><urls><related-urls><url>http://onlinelibrary.wiley.com/doi/10.1111/add.12162/abstract</url><url>http://onlinelibrary.wiley.com/store/10.1111/add.12162/asset/add12162.pdf?v=1&amp;t=hyzjsc9z&amp;s=4439c118749e511d7206c6e558e924116ab44410</url></related-urls><pdf-urls><url>http://onlinelibrary.wiley.com/store/10.1111/add.12162/asset/add12162.pdf?v=1&amp;t=hyzj5yyy&amp;s=bb2c883d2f8a4b56763a284694564e445371e894</url></pdf-urls></urls><electronic-resource-num>10.1111/add.12162</electronic-resource-num><remote-database-provider>Wiley Online Library</remote-database-provider><language>en</language><access-date>2014/08/18/08:22:17</access-date></record></Cite></EndNote>7. This study investigated this topic.

Definition and related problems
Pathological gaming can be defined as poor control of computer or game console use that leads to distress and impairment  HYPERLINK \l "_ENREF_8" \o "Pies, 2009 #45"  ADDIN EN.CITE <EndNote><Cite><Author>Pies</Author><Year>2009</Year><RecNum>53</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>53</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">53</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pies, Ronald</author></authors></contributors><titles><title>Should DSM-V Designate �Internet Addiction� a Mental Disorder?</title><secondary-title>Psychiatry (Edgmont)</secondary-title></titles><periodical><full-title>Psychiatry (Edgmont)</full-title></periodical><pages>31-37</pages><volume>6</volume><number>2</number><dates><year>2009</year></dates><isbn>1550-5952</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719452/</url></related-urls></urls></record></Cite></EndNote>8 and can be understood as uncontrollable and destructive uses or activities  HYPERLINK \l "_ENREF_9" \o "Mendelson, 1986 #80"  ADDIN EN.CITE <EndNote><Cite><Author>Mendelson</Author><Year>1986</Year><RecNum>80</RecNum><DisplayText><style face="superscript">9</style></DisplayText><record><rec-number>80</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">80</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Mendelson, J.</author><author>Mello, N.</author></authors></contributors><titles><title>The addictive personality</title></titles><edition>Chelsea-House</edition><dates><year>1986</year><pub-dates><date>1986</date></pub-dates></dates><pub-location>New York</pub-location><urls></urls></record></Cite></EndNote>9. The main problem is that there is no agreement to distinguish what pathological gaming is, and its differences from excessive gaming and different cut-off have been suggested  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47" 6, HYPERLINK \l "_ENREF_10" \o "Griffiths, 1995 #68" 10, HYPERLINK \l "_ENREF_11" \o "Wan, 2006 #78" 11. Most studies using screening or assessment instruments distinguish two classifications for defining pathological gaming, i.e., the monothetic and polythetic formats, as suggested since the DSM-IV for qualifying a diagnosis  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122" 12, HYPERLINK \l "_ENREF_13" \o "Griffiths, 2010 #49" 13. The monothetic format requires that all criteria be met, whereas the polythetic format is less strict as it requires that at least half of them be endorsed  HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122"  ADDIN EN.CITE <EndNote><Cite><Author>Lemmens</Author><Year>2009</Year><RecNum>46</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">46</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lemmens, Jeroen S.</author><author>Valkenburg, Patti M.</author><author>Peter, Jochen</author></authors></contributors><titles><title>Development and validation of a game addiction scale for adolescents</title><secondary-title>Media Psychology</secondary-title></titles><periodical><full-title>Media Psychology</full-title></periodical><pages>77-95</pages><volume>12</volume><number>1</number><keywords><keyword>adolescents</keyword><keyword>computer game addiction</keyword><keyword>Game Addiction Scale</keyword><keyword>psychometrics</keyword><keyword>test validity</keyword></keywords><dates><year>2009</year><pub-dates><date>2009</date></pub-dates></dates><isbn>1532-785X(Electronic);1521-3269(Print)</isbn><urls><related-urls><url>files/159/2009-03373-004.html</url></related-urls></urls><electronic-resource-num>10.1080/15213260802669458</electronic-resource-num><remote-database-provider>APA PsycNET</remote-database-provider></record></Cite></EndNote>12. That is to say, polythetic format is less strict and the underlying pathology can be manifested in clinically diverse ways. Monothetically-classified gamers constitute a small group, with a prevalence estimated at between 0.4% and 4% by Arnesen  HYPERLINK \l "_ENREF_5" \o "Arnesen, 2010 #281"  ADDIN EN.CITE <EndNote><Cite><Author>Arnesen</Author><Year>2010</Year><RecNum>281</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>281</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">281</key></foreign-keys><ref-type name="Thesis">32</ref-type><contributors><authors><author>Arnesen, Anette Addington</author></authors></contributors><titles><title>Video Game Addiction among Young Adults in Norway: Prevalence and Health</title></titles><dates><year>2010</year><pub-dates><date>2010</date></pub-dates></dates><pub-location>Norway</pub-location><publisher>University of Bergen</publisher><urls></urls></record></Cite></EndNote>5, at around 2% by other researchers  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47" 6, HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122" 12, HYPERLINK \l "_ENREF_14" \o "Kuss, 2012 #105" 14, or even 0.2% in a recent German study  HYPERLINK \l "_ENREF_4" \o "Festl, 2013 #103"  ADDIN EN.CITE <EndNote><Cite><Author>Festl</Author><Year>2013</Year><RecNum>103</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>103</rec-number><foreign-keys><key app="EN" db-id="5rr222s25s5pr0evds5vdew62trvp00fatts">103</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Festl, Ruth</author><author>Scharkow, Michael</author><author>Quandt, Thorsten</author></authors></contributors><titles><title>Problematic computer game use among adolescents, younger and older adults</title><secondary-title>Addiction</secondary-title></titles><periodical><full-title>Addiction</full-title><abbr-1>Addiction</abbr-1></periodical><pages>592-599</pages><volume>108</volume><number>3</number><keywords><keyword>adolescents</keyword><keyword>adults</keyword><keyword>gaming addiction</keyword><keyword>prevalence study</keyword><keyword>problematic computer game use</keyword></keywords><dates><year>2013</year><pub-dates><date>2013</date></pub-dates></dates><isbn>1360-0443</isbn><urls><related-urls><url>http://onlinelibrary.wiley.com/doi/10.1111/add.12016/abstract</url><url>files/1006/abstract.html</url></related-urls><pdf-urls><url>files/1007/Festl et al. - 2013 - Problematic computer game use among adolescents, y.pdf</url></pdf-urls></urls><electronic-resource-num>10.1111/add.12016</electronic-resource-num><remote-database-provider>Wiley Online Library</remote-database-provider><language>en</language><access-date>2013/07/30/09:31:26</access-date></record></Cite></EndNote>4. DSM-IV focuses more on the polythetic format for a diagnosis of pathological and addictive disorders, but such cut-off were described as too liberal for non-substance-related use  HYPERLINK \l "_ENREF_15" \o "First, 2004 #31"  ADDIN EN.CITE <EndNote><Cite><Author>First</Author><Year>2004</Year><RecNum>31</RecNum><Prefix>see for example </Prefix><DisplayText>see for example <style face="superscript">15</style></DisplayText><record><rec-number>31</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">31</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>First, Michael B.</author><author>Frances, Allen</author><author>Pincus, Harold Alan</author></authors></contributors><titles><title>DSM-IV-TR Guidebook</title></titles><keywords><keyword>Medical / Psychiatry / General</keyword><keyword>Mental Disorders - classification</keyword><keyword>Mental Disorders - diagnosis</keyword><keyword>Mental Disorders/ classification</keyword><keyword>Mental illness</keyword><keyword>Mental illness - Diagnosis</keyword><keyword>Mental illness/ Classification/ Handbooks, manuals, etc</keyword><keyword>Mental illness/ Diagnosis/ Handbooks, manuals, etc</keyword><keyword>Psychology / Mental Illness</keyword></keywords><dates><year>2004</year></dates><publisher>American Psychiatric Pub</publisher><isbn>9781585620685</isbn><urls></urls></record></Cite></EndNote>see for example 15. Thus, using the polythetic format may result in overestimating the prevalence of pathological gaming, from 16%  HYPERLINK \l "_ENREF_16" \o "Griffiths, 1995 #114"  ADDIN EN.CITE <EndNote><Cite><Author>Griffiths</Author><Year>1995</Year><RecNum>114</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>114</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">114</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Griffiths, M. D.</author></authors></contributors><titles><title>Technological addictions</title><secondary-title>Clinical Psychology Forum</secondary-title></titles><periodical><full-title>Clinical Psychology Forum</full-title></periodical><pages>14-19</pages><volume>76</volume><dates><year>1995</year></dates><urls></urls></record></Cite></EndNote>16 to 39%  HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47"  ADDIN EN.CITE <EndNote><Cite><Author>Charlton</Author><Year>2007</Year><RecNum>47</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>47</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">47</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Charlton, J.</author><author>Danforth, I.</author></authors></contributors><titles><title>Distinguishing addiction and high engagement in the context of online game playing</title><secondary-title>Computers in Human Behavior</secondary-title></titles><periodical><full-title>Computers in Human Behavior</full-title></periodical><pages>1531-1548</pages><volume>23</volume><number>3</number><keywords><keyword>Addiction</keyword><keyword>massively_multiplayer_online_games</keyword><keyword>methodology</keyword><keyword>online</keyword><keyword>videogames</keyword></keywords><dates><year>2007</year><pub-dates><date>2007/05//</date></pub-dates></dates><isbn>07475632</isbn><urls><related-urls><url>http://dx.doi.org/10.1016/j.chb.2005.07.002</url></related-urls></urls><electronic-resource-num>10.1016/j.chb.2005.07.002</electronic-resource-num><remote-database-provider>CiteULike</remote-database-provider><access-date>2012/08/20/12:16:36</access-date></record></Cite></EndNote>6 or 44.3%  HYPERLINK \l "_ENREF_13" \o "Griffiths, 2010 #49"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 13. Thereby, several authors recommend using the monothetic format to diagnose pathological gaming  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_1" \o "van Rooij, 2010 #39" 1, HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47" 6, HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122" 12, HYPERLINK \l "_ENREF_13" \o "Griffiths, 2010 #49" 13, HYPERLINK \l "_ENREF_17" \o "Hussain, 2012 #50" 17. Unfortunately, no cut-off for gaming is provided in the DSM-5, and more investigations are needed to identify pathological gaming  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_18" \o "Vakili, 2011 #94" 18, HYPERLINK \l "_ENREF_19" \o "Petry, 2013 #104" 19.

Correlates of pathological gaming
Correlates of pathological gaming is an important topic, as some authors distinguish excessive from pathological gaming based on the associated negative consequences for daily life  HYPERLINK \l "_ENREF_14" \o "Kuss, 2012 #105"  ADDIN EN.CITE <EndNote><Cite><Author>Kuss</Author><Year>2012</Year><RecNum>105</RecNum><DisplayText><style face="superscript">14</style></DisplayText><record><rec-number>105</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">105</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kuss, Daria J.</author><author>Griffiths, Mark D.</author></authors></contributors><titles><title>La d�pendance aux jeux vid�o sur internet : une revue syst�matique des recherches empiriques disponibles dans la litt�rature</title><secondary-title>Adolescence</secondary-title></titles><periodical><full-title>Adolescence</full-title></periodical><pages>17-17</pages><volume>79</volume><number>1</number><dates><year>2012</year></dates><isbn>0751-7696, 1969-6736</isbn><work-type>10.3917/ado.079.0017</work-type><urls><related-urls><url>http://www.cairn.info/resume.php?ID_ARTICLE=ADO_079_0017</url></related-urls></urls></record></Cite></EndNote>14. Thereby, this information may be useful to separate pathological gamers from the others. Pathological gaming has a number of well-known detrimental psychological, social and professional effects. Gaming is associated with an increased risk of developing patterns of problematic gambling  HYPERLINK \l "_ENREF_20" \o "Haagsma, 2012 #49"  ADDIN EN.CITE <EndNote><Cite><Author>Haagsma</Author><Year>2012</Year><RecNum>49</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>49</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">49</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Haagsma, Maria C.</author><author>Pieterse, Marcel E.</author><author>Peters, Oscar</author></authors></contributors><titles><title>The prevalence of problematic video gamers in the Netherlands</title><secondary-title>Cyberpsychology, behavior and social networking</secondary-title><alt-title>Cyberpsychol Behav Soc Netw</alt-title></titles><periodical><full-title>Cyberpsychology, behavior and social networking</full-title><abbr-1>Cyberpsychol Behav Soc Netw</abbr-1></periodical><alt-periodical><full-title>Cyberpsychology, behavior and social networking</full-title><abbr-1>Cyberpsychol Behav Soc Netw</abbr-1></alt-periodical><pages>162-168</pages><volume>15</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>Behavior, Addictive</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Internet</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Netherlands</keyword><keyword>Prevalence</keyword><keyword>Questionnaires</keyword><keyword>Self Concept</keyword><keyword>Video Games</keyword></keywords><dates><year>2012</year><pub-dates><date>2012/03//</date></pub-dates></dates><isbn>2152-2723</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/22313358</url></related-urls></urls><electronic-resource-num>10.1089/cyber.2011.0248</electronic-resource-num><remote-database-provider>NCBI PubMed</remote-database-provider><access-date>2012/08/20/12:25:21</access-date></record></Cite></EndNote>20 and with comorbidity factors such as anxiety, depression, social phobia, panic disorders (Allison et al., 2006), loneliness  HYPERLINK \l "_ENREF_17" \o "Hussain, 2012 #50"  ADDIN EN.CITE <EndNote><Cite><Author>Hussain</Author><Year>2012</Year><RecNum>50</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>50</rec-number><foreign-keys><key app="EN" db-id="dxret5s2ad2ra8erswtpdev8055faztz9p0t">50</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hussain, Z.</author><author>Griffiths, M. D.</author><author>Baguley, T.</author></authors></contributors><titles><title>Online gaming addiction: classification, prediction and associated risk factors</title><secondary-title>Addiction Research and Theory</secondary-title><short-title>Hussain, Z., Griffiths, M.D. &amp; Baguley, T. (2012). Online gaming addiction</short-title></titles><periodical><full-title>Addiction Research and Theory</full-title></periodical><keywords><keyword>academia</keyword><keyword>academics</keyword><keyword>Biology</keyword><keyword>Chemistry</keyword><keyword>Computer Science</keyword><keyword>Earth Sciences</keyword><keyword>Economics</keyword><keyword>English</keyword><keyword>Geography</keyword><keyword>History</keyword><keyword>Law</keyword><keyword>Math</keyword><keyword>Medicine</keyword><keyword>Philosophy</keyword><keyword>Physics</keyword><keyword>Political Science</keyword><keyword>Psychology</keyword><keyword>Religion</keyword><keyword>research</keyword><keyword>universities</keyword></keywords><dates><year>2012</year><pub-dates><date>2012 in press</date></pub-dates></dates><urls><related-urls><url>http://nottinghamtrent.academia.edu/MarkGriffiths/Papers/1126860/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors._Addiction_Research_and_Theory_in_press</url><url>files/607/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors.html</url></related-urls></urls><access-date>2012/08/20/12:20:14</access-date></record></Cite></EndNote>17, social skill deficits  HYPERLINK \l "_ENREF_21" \o "Caplan, 2005 #187"  ADDIN EN.CITE <EndNote><Cite><Author>Caplan</Author><Year>2005</Year><RecNum>187</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>187</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">187</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Caplan, Scott E.</author></authors></contributors><titles><title>A Social Skill Account of Problematic Internet Use</title><secondary-title>Journal of Communication</secondary-title></titles><periodical><full-title>Journal of Communication</full-title></periodical><pages>721-736</pages><volume>55</volume><number>4</number><dates><year>2005</year></dates><isbn>1460-2466</isbn><work-type>10.1111/j.1460-2466.2005.tb03019.x</work-type><urls><related-urls><url>http://onlinelibrary.wiley.com/doi/10.1111/j.1460-2466.2005.tb03019.x/abstract</url></related-urls></urls></record></Cite></EndNote>21, sadness and suicidal ideation  HYPERLINK \l "_ENREF_3" \o "Messias, 2011 #46"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 3, introversion, neuroticism and impulsivity  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_5" \o "Arnesen, 2010 #281" 5, HYPERLINK \l "_ENREF_14" \o "Kuss, 2012 #105" 14, HYPERLINK \l "_ENREF_22" \o "Caplan, 2009 #236" 22-25. Pathological gaming is also associated with family and social problems  HYPERLINK \l "_ENREF_25" \o "Peters, 2008 #97"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 25-30 or substance abuse disorders  HYPERLINK \l "_ENREF_31" \o "Anderson, 2001 #71"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 31-34.

This study compared two classifications for defining pathological gaming (polythetic vs. monothetic formats). Associations with mental, health and social issues known to be problematic among pathological gamers were examined to test how monothetically and polythetically-defined gamers was a discriminant cut-off.

Methods
Participants and procedure
The data used in this study were obtained from the Cohort Study on Substance Use Risk Factors (C-SURF). C-SURF is a longitudinal study designed to assess substance use patterns and related consequences among young Swiss men. Enrolment took place between August 23, 2010 and November 15, 2011 in three out of six army recruitment centers located in Lausanne (French-speaking), and Windisch and Mels (German-speaking). These three centers cover 21 of 26 cantons in Switzerland, including all French-speaking cantons. In Switzerland, army recruitment is mandatory, so all young men around 20 years old were eligible for study inclusion and the sample was highly representative of the Swiss young men and did not focus only on army recruits. This population is the one most involved in game use as it was constituted by young men around 20 years old  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_26" \o "Griffiths, 2004 #75" 26, HYPERLINK \l "_ENREF_35" \o "Tejeiro Salguero, 2002 #70" 35. A total of 5,990 participants completed the baseline questionnaire. Missing values among participants were deleted listwise, so the study finally included a total of 5,663 participants (94.5% of the sample, with only 0.6% missing for the Game Addiction Scale). More information on sampling and non-response can be found in Studer et al.  HYPERLINK \l "_ENREF_36" \o "Studer,  #47"  ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>Studer</Author><RecNum>47</RecNum><DisplayText><style face="superscript">36</style></DisplayText><record><rec-number>47</rec-number><foreign-keys><key app="EN" db-id="d5wd92w09tpswvep0t9v02s30xr20dzw900s">47</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Studer, Joseph</author><author>Baggio, St�phanie</author><author>Mohler-Kuo, Meichun</author><author>Dermota, Petra</author><author>Gaume, Jacques</author><author>Bertholet, Nicolas</author><author>Daeppen, Jean-Bernard</author><author>Gmel, Gerhard</author></authors></contributors><titles><title>Examining non-response bias in substance use research�Are late respondents proxies for non-respondents?</title><secondary-title>Drug and Alcohol Dependence</secondary-title><alt-title>Drug and Alcohol Dependence</alt-title></titles><periodical><full-title>Drug and Alcohol Dependence</full-title><abbr-1>Drug Alcohol Depend</abbr-1></periodical><alt-periodical><full-title>Drug and Alcohol Dependence</full-title><abbr-1>Drug Alcohol Depend</abbr-1></alt-periodical><keywords><keyword>Early respondent</keyword><keyword>Later respondent</keyword><keyword>Non-response bias</keyword><keyword>Substance use</keyword><keyword>Young men</keyword></keywords><dates></dates><isbn>0376-8716</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S0376871613000884</url><url>files/256/S0376871613000884.html</url></related-urls><pdf-urls><url>files/446/Studer et al. - Examining non-response bias in substance use resea.pdf</url></pdf-urls></urls><electronic-resource-num>10.1016/j.drugalcdep.2013.02.029</electronic-resource-num><remote-database-provider>ScienceDirect</remote-database-provider><access-date>2013/04/02/13:43:14</access-date></record></Cite></EndNote>36. Briefly, non-respondents used more alcohol, tobacco and cannabis than respondents, but the magnitude of the differences was small, indicating small non-response bias. The study protocol (Protocol No. 15/07) was approved by the Ethics Committee for Clinical Research of Lausanne University Medical School.

Measures
Game Addiction Scale. The 7-item short version of the Game Addiction Scale  HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122"  ADDIN EN.CITE <EndNote><Cite><Author>Lemmens</Author><Year>2009</Year><RecNum>46</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">46</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lemmens, Jeroen S.</author><author>Valkenburg, Patti M.</author><author>Peter, Jochen</author></authors></contributors><titles><title>Development and validation of a game addiction scale for adolescents</title><secondary-title>Media Psychology</secondary-title></titles><periodical><full-title>Media Psychology</full-title></periodical><pages>77-95</pages><volume>12</volume><number>1</number><keywords><keyword>adolescents</keyword><keyword>computer game addiction</keyword><keyword>Game Addiction Scale</keyword><keyword>psychometrics</keyword><keyword>test validity</keyword></keywords><dates><year>2009</year><pub-dates><date>2009</date></pub-dates></dates><isbn>1532-785X(Electronic);1521-3269(Print)</isbn><urls><related-urls><url>files/159/2009-03373-004.html</url></related-urls></urls><electronic-resource-num>10.1080/15213260802669458</electronic-resource-num><remote-database-provider>APA PsycNET</remote-database-provider></record></Cite></EndNote>12 was used to assess the use of games during the past six months. The criteria included salience, tolerance, mood management, relapse, withdrawal, conflicts and problems. The questions clearly deal about gaming, including online (conducted on a computer network, mostly on the Internet) and offline (not played on the Internet, performed on a computer of a game console) gaming. We also added to the original questions of Lemmens et al. a particular hint to Internet gaming. For the seven items, 5-point scale answers were used (� = .86), ranging from  never  (coded=1), through  sometimes  (coded=3),  to  very often  (coded=5). Following Lemmens et al., those who scored �sometimes� or more on all seven items were defined as �monothetic gamers� and those who scored �sometimes� or more on at least half of the items (four-six of seven items) as �polythetic gamers�. The other users were also taken into account: �rare or non- gamers� never answered �sometimes� or more (zero of seven items) and �non-problematic gamers� scored �sometimes� or more on a few items (one-three of seven items).
Mental, social and physical factors and consequences were also assessed.
Depression. The Major Depressive Inventory (ICD-10) � WHO-MDI was used to determine the level of depression in the last 2 weeks  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_37" \o "Bech, 2001 #45" 37, HYPERLINK \l "_ENREF_38" \o "Olsen, 2003 #7" 38. A six-point scale from �never� (0) to �all the time� (5) was used, and a total score of the 10 criteria was computed (� = .91).
Physical and mental health. The physical and mental health for the past 4 weeks was assessed with the Short Form Health Survey (SF-12)  HYPERLINK \l "_ENREF_39" \o "Ware, 1996 #54"  ADDIN EN.CITE <EndNote><Cite><Author>Ware</Author><Year>1996</Year><RecNum>54</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>54</rec-number><foreign-keys><key app="EN" db-id="5rr222s25s5pr0evds5vdew62trvp00fatts">54</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ware, J., Jr.</author><author>Kosinski, M.</author><author>Keller, S. D.</author></authors></contributors><titles><title>A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity</title><secondary-title>Medical Care</secondary-title><alt-title>Med Care</alt-title><short-title>A 12-Item Short-Form Health Survey</short-title></titles><periodical><full-title>Medical Care</full-title><abbr-1>Med Care</abbr-1></periodical><alt-periodical><full-title>Medical Care</full-title><abbr-1>Med Care</abbr-1></alt-periodical><pages>220-233</pages><volume>34</volume><number>3</number><keywords><keyword>Cross-Sectional Studies</keyword><keyword>Health Status</keyword><keyword>Health Surveys</keyword><keyword>Humans</keyword><keyword>Longitudinal Studies</keyword><keyword>Mental Health</keyword><keyword>Outcome Assessment (Health Care)</keyword><keyword>Regression Analysis</keyword><keyword>Reproducibility of Results</keyword><keyword>United States</keyword></keywords><dates><year>1996</year><pub-dates><date>1996/03//</date></pub-dates></dates><isbn>0025-7079</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/8628042</url></related-urls></urls><remote-database-provider>NCBI PubMed</remote-database-provider></record></Cite></EndNote>39, with two subscales: mental and social health, and physical health. The subscales were computed according to the standard scoring, giving 2 composite scores ranging from 0 (health problem) to 100 (no health problem).
Consequences. Seventeen consequences were selected from standard instruments  HYPERLINK \l "_ENREF_40" \o "Wechsler, 1994 #102"  ADDIN EN.CITE  ADDIN EN.CITE.DATA 40-42. They dealt with social/personal and health consequences (� = .73). Each consequence was coded 0 if it did not occur in the past 12 months and 1 if it occurs at least one time during the past 12 months. Two mean score of consequences were computed, one for social consequences (physical fight, problems with family, problems with friends, performed poorly at school or work, theft, trouble with police, regretted sexual intercourse, sexual intercourse without condom, damaged properties) and one for health consequences (accident/injury, admitted to an emergency room, attempted suicide, required medical treatment, spent a night in hospital, outpatient surgery, treated in an emergency room because of an accident/injury, went to an emergency department because of problems with substance use). Scores ranged from 0 to 1.
Finally, substance use, problematic substance use and gambling were assessed.
Gambling. Seven questions focused on gambling behavior (from the largest survey in Switzerland, the Swiss Health Survey): these concerned lottery and bets, electronic lottery, gambling machines, gambling tables in casinos, chance/money games on the Internet, money games and card games with money, and other money and chance games. Each gambling question was coded �1� when it had occurred during the previous 12 months and �0� if it had not occurred. A total gambling score was computed, according to the number of gambling behaviors exhibited (from 0 to 7, � = .66).
Illicit drug use and problematic substance use. Eighteen questions measured the use of licit drugs (alcohol, tobacco) and illicit drugs (cannabis and 15 others illicit drugs) during the past 12 months. They were coded as  used  or  non-used  and we computed a total score of used drugs ranging from 0 to 18 (� = .84). Alcohol dependence (DSM-IV criteria for alcohol dependence, with a total score between 0 �no dependence� to 7 �severe dependence�) and problematic cannabis use (Cannabis Use Disorder Identification Test, CUDIT  HYPERLINK \l "_ENREF_43" \o "Adamson, 2003 #12"  ADDIN EN.CITE <EndNote><Cite><Author>Adamson</Author><Year>2003</Year><RecNum>12</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>12</rec-number><foreign-keys><key app="EN" db-id="dez2frrdksszacevdr250prg5s0d9terrxxw">12</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adamson, Simon J.</author><author>Sellman, J. Douglas</author></authors></contributors><titles><title>A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample</title><secondary-title>Drug and Alcohol Review</secondary-title><alt-title>Drug Alcohol Rev</alt-title><short-title>A prototype screening instrument for cannabis use disorder</short-title></titles><periodical><full-title>Drug and Alcohol Review</full-title><abbr-1>Drug Alcohol Rev</abbr-1></periodical><alt-periodical><full-title>Drug and Alcohol Review</full-title><abbr-1>Drug Alcohol Rev</abbr-1></alt-periodical><pages>309-315</pages><volume>22</volume><number>3</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Alcoholism</keyword><keyword>Comorbidity</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Marijuana Abuse</keyword><keyword>Mass Screening</keyword><keyword>Middle Aged</keyword><keyword>Motivation</keyword><keyword>Questionnaires</keyword><keyword>Reproducibility of Results</keyword></keywords><dates><year>2003</year><pub-dates><date>2003/09//</date></pub-dates></dates><isbn>0959-5236</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/15385225</url></related-urls></urls><electronic-resource-num>10.1080/0959523031000154454</electronic-resource-num><remote-database-provider>NCBI PubMed</remote-database-provider></record></Cite></EndNote>43, total score between 0 �no problematic use � and 40 �severe problematic use�)  were also assessed.

Statistical analyses
Two kinds of analyses were conducted to test 1) the difference between polythetic and monothetic gamers, 2) to access the existence of different groups of gamers and especially the subgroup of monothetic gamers.
1) The difference between the four groups of gamers on the comorbidity factors presented above (physical and mental health, consequences, substance use and dependence) was accessed with one-way ANOVA with pairwise contrasts between adjacent groups.
2) Latent class analysis (LCA)  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_44" \o "Goodman, 1974 #80" 44, HYPERLINK \l "_ENREF_45" \o "Lazarsfeld, 1968 #122" 45 was performed to discover subgroups. LCA was used to see whether the seven items actually were responded in a similar way, or whether different groups of gamers exist that are not simply along a scale such as polythetic and monothetic where the assessment assumes that all items contribute in the same way to responses. LCA is a popular technique  HYPERLINK \l "_ENREF_46" \o "Feingold, 2013 #113"  ADDIN EN.CITE <EndNote><Cite><Author>Feingold</Author><Year>2013</Year><RecNum>113</RecNum><DisplayText><style face="superscript">46</style></DisplayText><record><rec-number>113</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">113</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Feingold, A.</author><author>Tibeiro, S. S.</author><author>Capaldi, D. M.</author></authors></contributors><titles><title>New Approaches for Examining Associations with Latent Categorical Variables: Applications to Substance Abuse and Aggression</title><secondary-title>Psychology of Addictive Behaviors</secondary-title></titles><periodical><full-title>Psychology of Addictive Behaviors</full-title></periodical><dates><year>2013</year><pub-dates><date>2013</date></pub-dates></dates><urls><related-urls><url>http://www.statmodel.com/papers_date.shtml</url></related-urls></urls></record></Cite></EndNote>46 which allows identifying subgroups of participants from their item responses patterns. The categorical classes are a latent variable, and posterior probabilities are used to assign each participant to the most likely latent class. The number of latent classes is unknown, and fit indices for various models are used to assess the optimal number of classes. Bayesian Information Criterion (BIC), sample-size adjusted BIC (ABIC) and Akaike Information Criterion (AIC) were used, for which lower values indicate better fit  HYPERLINK \l "_ENREF_47" \o "Raftery, 1995 #118"  ADDIN EN.CITE <EndNote><Cite><Author>Raftery</Author><Year>1995</Year><RecNum>118</RecNum><DisplayText><style face="superscript">47</style></DisplayText><record><rec-number>118</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">118</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Raftery, A. E.</author></authors></contributors><titles><title>Bayesian model selection in social research</title><secondary-title>Sociological Methodology</secondary-title></titles><periodical><full-title>Sociological Methodology</full-title></periodical><pages>111-163</pages><number>25</number><dates><year>1995</year><pub-dates><date>1995</date></pub-dates></dates><urls></urls></record></Cite></EndNote>47. The Lo-Mendel-Rubin likelihood ratio test (LMR LRT) indicates if the model with k-class is better than a model with k-1-class  HYPERLINK \l "_ENREF_48" \o "Lo, 2001 #116"  ADDIN EN.CITE <EndNote><Cite><Author>Lo</Author><Year>2001</Year><RecNum>116</RecNum><DisplayText><style face="superscript">48</style></DisplayText><record><rec-number>116</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">116</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lo, Yungtai</author><author>Mendell, Nancy R.</author><author>Rubin, Donald B.</author></authors></contributors><titles><title>Testing the number of components in a normal mixture</title><secondary-title>Biometrika</secondary-title><alt-title>Biometrika</alt-title></titles><periodical><full-title>Biometrika</full-title><abbr-1>Biometrika</abbr-1></periodical><alt-periodical><full-title>Biometrika</full-title><abbr-1>Biometrika</abbr-1></alt-periodical><pages>767-778</pages><volume>88</volume><number>3</number><keywords><keyword>Kullback Leibler information criterion</keyword><keyword>Likelihood ratio test</keyword><keyword>Normal mixture</keyword><keyword>Weighted sum of chi squared random variables</keyword></keywords><dates><year>2001</year><pub-dates><date>2001/01/10/</date></pub-dates></dates><isbn>0006-3444, 1464-3510</isbn><urls><related-urls><url>http://biomet.oxfordjournals.org/content/88/3/767</url><url>files/671/767.html</url></related-urls><pdf-urls><url>files/670/Lo et al. - 2001 - Testing the number of components in a normal mixtu.pdf</url></pdf-urls></urls><electronic-resource-num>10.1093/biomet/88.3.767</electronic-resource-num><remote-database-provider>biomet.oxfordjournals.org</remote-database-provider><language>en</language><access-date>2013/01/29/14:13:29</access-date></record></Cite></EndNote>48. A low p-value indicates that the model with k-1-class is rejected in favor of the model with k-class. The analysis was performed with Mplus 6  HYPERLINK \l "_ENREF_49" \o "Muth�n, 2010 #1"  ADDIN EN.CITE <EndNote><Cite><Author>Muth�n</Author><Year>2010</Year><RecNum>1</RecNum><DisplayText><style face="superscript">49</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="dez2frrdksszacevdr250prg5s0d9terrxxw">1</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Muth�n, L. K.</author><author>Muth�n, B. O.</author></authors></contributors><titles><title>Mplus user&apos;s guide. Sixth edition</title></titles><dates><year>2010</year><pub-dates><date>2010</date></pub-dates></dates><pub-location>Los Angeles, CA</pub-location><publisher>Muth�n &amp; Muth�n</publisher><urls></urls></record></Cite></EndNote>49. Descriptive statistics compared class assignment to the groups defined by Lemmens et al. recommendations.

Results
Sample characteristics
Preliminary results are presented in Table 1. A total of 2.3% of participants were monothetically-classified gamers, and 9.5% were polythetically-classified gamers. The participants showed low levels of problem for health or social factors and substance use. Polythetic and monothetic gamers appeared to have different results for some variables, including depression, anxiety, aggressiveness, physical health and substance use, with monothetic gamers having higher scores on these variables than polythetic gamers.

Please insert Table 1 about here

Comparison between rare or non-users, non-problematic, excessive and pathological gamers
Significant differences between the groups of gamers on the health, social, physical factors and consequences are presented in Table 2. Polythetic and monothetic gamers showed the same level of comorbidity factors for some variables, including mental health, social and health consequences and problematic cannabis use. On the opposite side, monothetic gamers had significantly more extreme scores than polythetic gamers for the other variables: depression, anxiety, aggressiveness, physical health, total of drug used, alcohol dependence and total score of gambling. In general, there was almost for all variables a monotonic relationship from rare or non-gamers to monothetic gamers. No alpha-error correction was performed, as the aim of the study was an exploratory one. However, the rate of significance (66.67%) was largely higher than the nominal 5% of type I error rate, so they cannot all be due to type I error and multiple tests  HYPERLINK \l "_ENREF_50" \o "Iglesias Rutishauser, 2011 #275"  ADDIN EN.CITE <EndNote><Cite><Author>Iglesias Rutishauser</Author><Year>2011</Year><RecNum>275</RecNum><DisplayText><style face="superscript">50</style></DisplayText><record><rec-number>275</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">275</key></foreign-keys><ref-type name="Thesis">32</ref-type><contributors><authors><author>Iglesias Rutishauser, Katia</author></authors></contributors><titles><title>L&apos;utilisation des mod�les � effets mixtes avec effets al�atoires crois�s pour l�analyse de donn�es de type questionnaire dans le champ de la satisfaction au travail</title></titles><dates><year>2011</year><pub-dates><date>2011</date></pub-dates></dates><pub-location>Geneva</pub-location><publisher>University of Geneva</publisher><urls></urls></record></Cite></EndNote>50.

Please insert Table 2 about here

Latent Class Analysis
Six models were performed to estimate the optimal number of classes. The fit indices are presented in Table 3. The 4-class model was the best one. Even if BIC, ABIC and AIC decreased for the five-class model, the LMR LRT showed non-significant p-values for the five- and six-class models.

Please insert Table 3 about here

Table 4 presented the latent class profiles. Class 4 (37.24% of the participants) seemed to correspond to the non-users or rare users. Their most likely answer on the seven items was �never�. Class 3 (41.39% of the participants) was a subgroup constituted by non-problematic users: they endorsed more the answer �never� and �rarely� on the items, except for �longer use than intended� which had a probability of .410 to be endorsed. The two other classes referred to frequent users. Class 2 (5.16% of the participants) aggregated participants who reported the most �sometimes�, �often� and �very often� answers (Q1: 90.8% of the answers were �sometimes� or more, Q2: 92.7%, Q3: 81.5%, Q4: 70.3%, Q5: 53.4%, Q6: 57.8%, Q7: 62.3%), whereas class 1 (16.21% of the participants) endorsed most of the time �sometimes� answers, excepted for �upset when unable to play� (.333 answered �never� and .427 �rarely�). Descriptive statistics which compared class assignment to the groups defined by Lemmens et al. recommendations showed that class 2 met the higher number of criteria (5.11) and the higher percentage of monothetically-classified gamers (50.4%). Class 1 met in average fewer criterions (3.418) and was constituted with most polythetically-classified gamers (64.8%). Generally, the findings from LCA confirm that a dimensional scale can be constructed from the 7 items. 

Please insert Table 4 about here

Discussion
The aim of this study was to explore the differences between subgroups of gamers and particularly to test whether the distinction between polythetically and monothetically-defined gamers was relevant. To our knowledge, no previous study has focused on the differences between the two on health and social issues, even if some researchers are beginning to agree on the use of the monothetic format to diagnose pathological gaming  ADDIN EN.CITE  ADDIN EN.CITE.DATA  HYPERLINK \l "_ENREF_4" \o "Festl, 2013 #103" 4, HYPERLINK \l "_ENREF_6" \o "Charlton, 2007 #47" 6, HYPERLINK \l "_ENREF_17" \o "Hussain, 2012 #50" 17. 
With 2.3% of participants revealed to be monothetically-classified gamers and an additional 9.5% found to be polythetically-classified gamers, the prevalence rates in this study were comparable with those found by the researchers who developed the scale  HYPERLINK \l "_ENREF_12" \o "Lemmens, 2009 #122"  ADDIN EN.CITE <EndNote><Cite><Author>Lemmens</Author><Year>2009</Year><RecNum>122</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>122</rec-number><foreign-keys><key app="EN" db-id="2dw5a2xx3052freee5x5tv0ndrvaxxsr5p5r">122</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lemmens, Jeroen S.</author><author>Valkenburg, Patti M.</author><author>Peter, Jochen</author></authors></contributors><titles><title>Development and validation of a game addiction scale for adolescents</title><secondary-title>Media Psychology</secondary-title></titles><periodical><full-title>Media Psychology</full-title></periodical><pages>77-95</pages><volume>12</volume><number>1</number><keywords><keyword>adolescents</keyword><keyword>computer game addiction</keyword><keyword>Game Addiction Scale</keyword><keyword>psychometrics</keyword><keyword>test validity</keyword></keywords><dates><year>2009</year><pub-dates><date>2009</date></pub-dates></dates><isbn>1532-785X(Electronic);1521-3269(Print)</isbn><urls><related-urls><url>files/159/2009-03373-004.html</url></related-urls></urls><electronic-resource-num>10.1080/15213260802669458</electronic-resource-num><remote-database-provider>APA PsycNET</remote-database-provider></record></Cite></EndNote>12, but also with the results of other studies conducted in Switzerland  HYPERLINK \l "_ENREF_51" \o "Eidenbenz, 2011 #56"  ADDIN EN.CITE <EndNote><Cite><Author>Eidenbenz</Author><Year>2011</Year><RecNum>56</RecNum><DisplayText><style face="superscript">51</style></DisplayText><record><rec-number>56</rec-number><foreign-keys><key app="EN" db-id="rpt2va9fnwrvp9ez0psvee5ardzawe9pseza">56</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Eidenbenz, F.</author></authors><secondary-authors><author>M�ller,</author></secondary-authors></contributors><titles><title>Ambulante Versorgung und Behandlung von medien- und computers�chtigen Kindern und Jugendlichen und ihrer Eltern</title><secondary-title>Praxishandbuch f�r Therapeuten, P�dagogen und Eltern</secondary-title></titles><dates><year>2011</year></dates><pub-location>Stuttgart</pub-location><urls></urls></record></Cite></EndNote>51, Norway  HYPERLINK \l "_ENREF_52" \o "Johansson, 2004 #135"  ADDIN EN.CITE <EndNote><Cite><Author>Johansson</Author><Year>2004</Year><RecNum>135</RecNum><DisplayText><style face="superscript">52</style></DisplayText><record><rec-number>135</rec-number><foreign-keys><key app="EN" db-id="2dw5a2xx3052freee5x5tv0ndrvaxxsr5p5r">135</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Johansson, Agneta</author><author>G�testam, K. Gunnar</author></authors></contributors><titles><title>Problems with computer games without monetary reward: similarity to pathological gambling</title><secondary-title>Psychological reports</secondary-title><alt-title>Psychol Rep</alt-title><short-title>Problems with computer games without monetary reward</short-title></titles><periodical><full-title>Psychological Reports</full-title></periodical><alt-periodical><full-title>Psychological reports</full-title><abbr-1>Psychol Rep</abbr-1></alt-periodical><pages>641-650</pages><volume>95</volume><number>2</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Child</keyword><keyword>Computers</keyword><keyword>Demography</keyword><keyword>Economics</keyword><keyword>Gambling</keyword><keyword>Humans</keyword><keyword>Middle Aged</keyword><keyword>Questionnaires</keyword><keyword>Reward</keyword><keyword>Video Games</keyword></keywords><dates><year>2004</year><pub-dates><date>2004/10//</date></pub-dates></dates><isbn>0033-2941</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/15587233</url></related-urls></urls><remote-database-provider>NCBI PubMed</remote-database-provider><access-date>2012/08/20/14:15:11</access-date></record></Cite></EndNote>52 and Finland  HYPERLINK \l "_ENREF_53" \o "Kaltiala-Heino, 2004 #116"  ADDIN EN.CITE <EndNote><Cite><Author>Kaltiala-Heino</Author><Year>2004</Year><RecNum>116</RecNum><DisplayText><style face="superscript">53</style></DisplayText><record><rec-number>116</rec-number><foreign-keys><key app="EN" db-id="2dw5a2xx3052freee5x5tv0ndrvaxxsr5p5r">116</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaltiala-Heino, R.</author><author>Lintonenm, T.</author><author>Rimpela, A.</author></authors></contributors><titles><title>Internet addiction? Potentially problematic use of the Internet in a population of 12-18 year-old adolescents</title><secondary-title>Addiction Research and Theory</secondary-title></titles><periodical><full-title>Addiction Research and Theory</full-title></periodical><pages>89-96</pages><volume>12</volume><number>1</number><dates><year>2004</year><pub-dates><date>2004</date></pub-dates></dates><urls></urls></record></Cite></EndNote>53. It is also important to note that, despite not using the same scale to measure game overuse, these studies reported similar proportions of pathological gamers, who corresponded here to the monothetically-classified gamers. The prevalence rate was lower in Germany (0.2%,  HYPERLINK \l "_ENREF_4" \o "Festl, 2013 #103"  ADDIN EN.CITE <EndNote><Cite><Author>Festl</Author><Year>2013</Year><RecNum>103</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>103</rec-number><foreign-keys><key app="EN" db-id="5rr222s25s5pr0evds5vdew62trvp00fatts">103</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Festl, Ruth</author><author>Scharkow, Michael</author><author>Quandt, Thorsten</author></authors></contributors><titles><title>Problematic computer game use among adolescents, younger and older adults</title><secondary-title>Addiction</secondary-title></titles><periodical><full-title>Addiction</full-title><abbr-1>Addiction</abbr-1></periodical><pages>592-599</pages><volume>108</volume><number>3</number><keywords><keyword>adolescents</keyword><keyword>adults</keyword><keyword>gaming addiction</keyword><keyword>prevalence study</keyword><keyword>problematic computer game use</keyword></keywords><dates><year>2013</year><pub-dates><date>2013</date></pub-dates></dates><isbn>1360-0443</isbn><urls><related-urls><url>http://onlinelibrary.wiley.com/doi/10.1111/add.12016/abstract</url><url>files/1006/abstract.html</url></related-urls><pdf-urls><url>files/1007/Festl et al. - 2013 - Problematic computer game use among adolescents, y.pdf</url></pdf-urls></urls><electronic-resource-num>10.1111/add.12016</electronic-resource-num><remote-database-provider>Wiley Online Library</remote-database-provider><language>en</language><access-date>2013/07/30/09:31:26</access-date></record></Cite></EndNote>4), but these authors did not focus only on young adults and prevalence rates are known to be higher among this population.
Not surprisingly, the different levels of game use had a strong impact on comorbidity factors, but relevant differences were detected between polythetic and monothetic gamers. Overall, rare or non-gamers had fewer problems than non-problematic gamers, and non-problematic gamers fewer problems than polythetic and monothetic gamers. This was true for all variables except health consequences, total of drug used, physical health (no difference between rare or non-gamers and non-problematic gamers), alcohol dependence and problematic cannabis use (no difference between non-problematic gamers and polythetic gamers). Thereby, polythetic gamers already had negative consequences and comorbidity factors associated with their game overuse and can be distinguished from non-problematic gamers. In addition to this result, polythetic gamers differed from monothetic gamers regarding 7 of the 11 health-, social- and physical factors. These two groups differed on depression, anxiety, aggressiveness, physical health, number of drug used, alcohol dependence and gambling behavior. Thus, the number of comorbidity factors was higher for monothetic gamers in comparison with polythetic gamers. No significant difference was found between polythetic and monothetic gamers regarding consequences (both social and health consequences), mental health or problematic cannabis use. Monothetic gamers seemed more vulnerable to neuroticism (depression, anxiety, aggressiveness) and others addictions like substance use and gambling patterns. Previous studies have shown that game overuse is a predictor for substance use  HYPERLINK \l "_ENREF_17" \o "Hussain, 2012 #50"  ADDIN EN.CITE <EndNote><Cite><Author>Hussain</Author><Year>2012</Year><RecNum>50</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>50</rec-number><foreign-keys><key app="EN" db-id="dxret5s2ad2ra8erswtpdev8055faztz9p0t">50</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hussain, Z.</author><author>Griffiths, M. D.</author><author>Baguley, T.</author></authors></contributors><titles><title>Online gaming addiction: classification, prediction and associated risk factors</title><secondary-title>Addiction Research and Theory</secondary-title><short-title>Hussain, Z., Griffiths, M.D. &amp; Baguley, T. (2012). Online gaming addiction</short-title></titles><periodical><full-title>Addiction Research and Theory</full-title></periodical><keywords><keyword>academia</keyword><keyword>academics</keyword><keyword>Biology</keyword><keyword>Chemistry</keyword><keyword>Computer Science</keyword><keyword>Earth Sciences</keyword><keyword>Economics</keyword><keyword>English</keyword><keyword>Geography</keyword><keyword>History</keyword><keyword>Law</keyword><keyword>Math</keyword><keyword>Medicine</keyword><keyword>Philosophy</keyword><keyword>Physics</keyword><keyword>Political Science</keyword><keyword>Psychology</keyword><keyword>Religion</keyword><keyword>research</keyword><keyword>universities</keyword></keywords><dates><year>2012</year><pub-dates><date>2012 in press</date></pub-dates></dates><urls><related-urls><url>http://nottinghamtrent.academia.edu/MarkGriffiths/Papers/1126860/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors._Addiction_Research_and_Theory_in_press</url><url>files/607/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors.html</url></related-urls></urls><access-date>2012/08/20/12:20:14</access-date></record></Cite></EndNote>17. Problematic gamers drink more, smoke more (cigarettes and cannabis), and have more issues with substance use  HYPERLINK \l "_ENREF_33" \o "Ko, 2006 #107"  ADDIN EN.CITE <EndNote><Cite><Author>Ko</Author><Year>2006</Year><RecNum>107</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><rec-number>107</rec-number><foreign-keys><key app="EN" db-id="2dw5a2xx3052freee5x5tv0ndrvaxxsr5p5r">107</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ko, Chih-Hung</author><author>Yen, Ju-Yu</author><author>Chen, Cheng-Chung</author><author>Chen, Sue-Huei</author><author>Wu, Kuanyi</author><author>Yen, Cheng-Fang</author></authors></contributors><titles><title>Tridimensional personality of adolescents with internet addiction and substance use experience</title><secondary-title>Canadian journal of psychiatry. Revue canadienne de psychiatrie</secondary-title><alt-title>Can J Psychiatry</alt-title></titles><periodical><full-title>Canadian journal of psychiatry. Revue canadienne de psychiatrie</full-title><abbr-1>Can J Psychiatry</abbr-1></periodical><alt-periodical><full-title>Canadian journal of psychiatry. Revue canadienne de psychiatrie</full-title><abbr-1>Can J Psychiatry</abbr-1></alt-periodical><pages>887-894</pages><volume>51</volume><number>14</number><keywords><keyword>Adolescent</keyword><keyword>Behavior, Addictive</keyword><keyword>Comorbidity</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Exploratory Behavior</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Internet</keyword><keyword>Male</keyword><keyword>Personality Disorders</keyword><keyword>Questionnaires</keyword><keyword>Substance-Related Disorders</keyword></keywords><dates><year>2006</year><pub-dates><date>2006/12//</date></pub-dates></dates><isbn>0706-7437</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/17249631</url></related-urls></urls><remote-database-provider>NCBI PubMed</remote-database-provider><access-date>2012/08/20/13:05:50</access-date></record></Cite></EndNote>33 than non-problematic gamers. We did not find a difference for problematic cannabis use, but alcohol dependence use and number of drug used were more pronounced for monothetic gamers than for any other group. Gambling patterns were also more prevalent among monothetic gamers, and these results concerning substance use and problematic behavior indicated that monothetic gamers may be especially vulnerable to other dependencies.
To summarize, monothetic gamers seemed to be a particular vulnerable subgroup and were clearly distinct from polythetic gamers when considering the associated comorbidity factors. Thus, the subdivision between polythetic and mmonothetic defined-gamers appeared as a relevant one. However, polythetic gamers already showed detrimental issues; even if the severity of mental health issues and dependencies was lower for this subgroup rather than for monothetic gamers. The fact that polythetic gamers have already game-related issues may have lead to classify them in the pathologic gamers in previous studies. However, the current study showed that there was different levels in game-related issues.

The LCA conducted to separate four subgroups, which was congruent with the four subgroups defined earlier. 5.16% of the participants were part of the group who mainly endorsed all of the 7 items (i.e. answered �sometimes� or more often more for more than half the participants, class 2). 16.21% of the gamers answered �sometimes� and �rarely� for most of the item and a majority of participants (class 1). Even if the prevalence of the criterions was lower than the one of Lemmens et al. recommendations (i.e. class 2 endorsed on average a total of 5.11 criterions instead of 7 for the group of monothetic gamers), the LCA showed that the groups defined previously were not only an artifact but could be differentiate in the results of the Game Addiction Scale, and that there was a significant difference between polythetic and monothetic gamers.

The main limitation of this study is that it was based on correlations, and we were thus not able to identify causal links between pathological gaming and associated comorbidity factors. Is pathological gaming a cause or a consequence? Or is it a symptom  HYPERLINK \l "_ENREF_54" \o "Ha, 2007 #63"  ADDIN EN.CITE <EndNote><Cite><Author>Ha</Author><Year>2007</Year><RecNum>63</RecNum><DisplayText><style face="superscript">54</style></DisplayText><record><rec-number>63</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">63</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ha, Jee Hyun</author><author>Kim, Su Yeon</author><author>Bae, Soojeong C.</author><author>Bae, Sujin</author><author>Kim, Hyungjun</author><author>Sim, Minyoung</author><author>Lyoo, In Kyoon</author><author>Cho, Soo Churl</author></authors></contributors><titles><title>Depression and Internet addiction in adolescents</title><secondary-title>Psychopathology</secondary-title><alt-title>Psychopathology</alt-title></titles><periodical><full-title>Psychopathology</full-title><abbr-1>Psychopathology</abbr-1></periodical><alt-periodical><full-title>Psychopathology</full-title><abbr-1>Psychopathology</abbr-1></alt-periodical><pages>424-430</pages><volume>40</volume><number>6</number><keywords><keyword>Adolescent</keyword><keyword>Adolescent Behavior</keyword><keyword>Behavior, Addictive</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Depression</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Internet</keyword><keyword>Korea</keyword><keyword>Male</keyword><keyword>Obsessive-Compulsive Disorder</keyword></keywords><dates><year>2007</year><pub-dates><date>2007</date></pub-dates></dates><isbn>1423-033X</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/17709972</url></related-urls></urls><electronic-resource-num>10.1159/000107426</electronic-resource-num><remote-database-provider>NCBI PubMed</remote-database-provider><access-date>2012/08/20/12:58:55</access-date></record></Cite></EndNote>54, a way of expressing depression or another personality disorder  HYPERLINK \l "_ENREF_8" \o "Pies, 2009 #45"  ADDIN EN.CITE <EndNote><Cite><Author>Pies</Author><Year>2009</Year><RecNum>45</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>45</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">45</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pies, Ronald</author></authors></contributors><titles><title>Should DSM-V Designate �Internet Addiction� a Mental Disorder?</title><secondary-title>Psychiatry (Edgmont)</secondary-title><alt-title>Psychiatry (Edgmont)</alt-title></titles><periodical><full-title>Psychiatry (Edgmont)</full-title><abbr-1>Psychiatry (Edgmont)</abbr-1></periodical><alt-periodical><full-title>Psychiatry (Edgmont)</full-title><abbr-1>Psychiatry (Edgmont)</abbr-1></alt-periodical><pages>31-37</pages><volume>6</volume><number>2</number><dates><year>2009</year><pub-dates><date>2009/02//</date></pub-dates></dates><isbn>1550-5952</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719452/</url></related-urls><pdf-urls><url>files/157/Pies - 2009 - Should DSM-V Designate �Internet Addiction� a Ment.pdf</url></pdf-urls></urls><remote-database-provider>PubMed Central</remote-database-provider><access-date>2012/08/20/12:01:19</access-date></record></Cite></EndNote>8? In all cases, pathological gamers constitute an at-risk population and need to be helped and treated  HYPERLINK \l "_ENREF_8" \o "Pies, 2009 #45"  ADDIN EN.CITE <EndNote><Cite><Author>Pies</Author><Year>2009</Year><RecNum>45</RecNum><DisplayText><style face="superscript">8</style></DisplayText><record><rec-number>45</rec-number><foreign-keys><key app="EN" db-id="wzrvwpsfwdpw52exdt1psvvndvd00spav5t0">45</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pies, Ronald</author></authors></contributors><titles><title>Should DSM-V Designate �Internet Addiction� a Mental Disorder?</title><secondary-title>Psychiatry (Edgmont)</secondary-title><alt-title>Psychiatry (Edgmont)</alt-title></titles><periodical><full-title>Psychiatry (Edgmont)</full-title><abbr-1>Psychiatry (Edgmont)</abbr-1></periodical><alt-periodical><full-title>Psychiatry (Edgmont)</full-title><abbr-1>Psychiatry (Edgmont)</abbr-1></alt-periodical><pages>31-37</pages><volume>6</volume><number>2</number><dates><year>2009</year><pub-dates><date>2009/02//</date></pub-dates></dates><isbn>1550-5952</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719452/</url></related-urls><pdf-urls><url>files/157/Pies - 2009 - Should DSM-V Designate �Internet Addiction� a Ment.pdf</url></pdf-urls></urls><remote-database-provider>PubMed Central</remote-database-provider><access-date>2012/08/20/12:01:19</access-date></record></Cite></EndNote>8. We can also mention the exploratory character of this study and the fact that we did not do alpha correction for multiple testing corrected p-values. Further studies may confirm that these results are substantial ones.
Another limitation was that the study design excluded women. Gaming behavior and its association with comorbidity factors must be studied within a sample of women, to assess the potential differences between men and women.
A last limitation was the assessment of anxiety and aggressiveness with a personality scale. Such a scale may be use as a proxy for the level of anxiety or aggressiveness in a given time period (i.e. the anxiety sensitivity is a risk factor for the development of anxiety disorders  HYPERLINK \l "_ENREF_55" \o "McLaughlin, 2007 #44"  ADDIN EN.CITE <EndNote><Cite><Author>McLaughlin</Author><Year>2007</Year><RecNum>44</RecNum><DisplayText><style face="superscript">55</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="5rr222s25s5pr0evds5vdew62trvp00fatts">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McLaughlin, Elizabeth N.</author><author>Stewart, Sherry H.</author><author>Taylor, Steven</author></authors></contributors><titles><title>Childhood anxiety sensitivity index factors predict unique variance in DSM-IV anxiety disorder symptoms</title><secondary-title>Cognitive Behaviour Therapy</secondary-title><alt-title>Cogn Behav Ther</alt-title></titles><periodical><full-title>Cognitive Behaviour Therapy</full-title><abbr-1>Cogn Behav Ther</abbr-1></periodical><alt-periodical><full-title>Cognitive Behaviour Therapy</full-title><abbr-1>Cogn Behav Ther</abbr-1></alt-periodical><pages>210-219</pages><volume>36</volume><number>4</number><keywords><keyword>Adolescent</keyword><keyword>Agoraphobia</keyword><keyword>Anxiety Disorders</keyword><keyword>Arousal</keyword><keyword>Child</keyword><keyword>Diagnosis, Differential</keyword><keyword>Diagnostic and Statistical Manual of Mental Disorders</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Individuality</keyword><keyword>Male</keyword><keyword>Obsessive-Compulsive Disorder</keyword><keyword>Panic Disorder</keyword><keyword>Personality Inventory</keyword><keyword>Phobic Disorders</keyword><keyword>psychometrics</keyword><keyword>Reproducibility of Results</keyword><keyword>Wounds and Injuries</keyword></keywords><dates><year>2007</year><pub-dates><date>2007</date></pub-dates></dates><isbn>1651-2316</isbn><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/18049946</url></related-urls></urls><electronic-resource-num>10.1080/16506070701499988</electronic-resource-num><remote-database-provider>NCBI PubMed</remote-database-provider></record></Cite></EndNote>55), but further investigations with psychological health or distress questionnaires are needed.

To conclude, we can observe that a clear distinction existed between monothetic and polythetic gamers, strengthening the choice of the monothetic format for diagnosis of pathological gamers and their differentiation from excessive gamers. Monothetic gamers endorsed more comorbidity factors associated with mental, health and substance use issues than polythetic gamers. However, game overuse (i.e. not yet pathological gaming) can lead to potential detrimental effects, as polythetic gamers already have a number of social and mental problems. Indeed, polythetic gamers may be more likely to shift to the monothetic classification  HYPERLINK \l "_ENREF_17" \o "Hussain, 2012 #50"  ADDIN EN.CITE <EndNote><Cite><Author>Hussain</Author><Year>2012</Year><RecNum>50</RecNum><DisplayText><style face="superscript">17</style></DisplayText><record><rec-number>50</rec-number><foreign-keys><key app="EN" db-id="dxret5s2ad2ra8erswtpdev8055faztz9p0t">50</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hussain, Z.</author><author>Griffiths, M. D.</author><author>Baguley, T.</author></authors></contributors><titles><title>Online gaming addiction: classification, prediction and associated risk factors</title><secondary-title>Addiction Research and Theory</secondary-title><short-title>Hussain, Z., Griffiths, M.D. &amp; Baguley, T. (2012). Online gaming addiction</short-title></titles><periodical><full-title>Addiction Research and Theory</full-title></periodical><keywords><keyword>academia</keyword><keyword>academics</keyword><keyword>Biology</keyword><keyword>Chemistry</keyword><keyword>Computer Science</keyword><keyword>Earth Sciences</keyword><keyword>Economics</keyword><keyword>English</keyword><keyword>Geography</keyword><keyword>History</keyword><keyword>Law</keyword><keyword>Math</keyword><keyword>Medicine</keyword><keyword>Philosophy</keyword><keyword>Physics</keyword><keyword>Political Science</keyword><keyword>Psychology</keyword><keyword>Religion</keyword><keyword>research</keyword><keyword>universities</keyword></keywords><dates><year>2012</year><pub-dates><date>2012 in press</date></pub-dates></dates><urls><related-urls><url>http://nottinghamtrent.academia.edu/MarkGriffiths/Papers/1126860/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors._Addiction_Research_and_Theory_in_press</url><url>files/607/Hussain_Z._Griffiths_M.D._and_Baguley_T._2012_._Online_gaming_addiction_classification_prediction_and_associated_risk_factors.html</url></related-urls></urls><access-date>2012/08/20/12:20:14</access-date></record></Cite></EndNote>17. Therefore, the polythetic screening is valuable for identifying �at risk� gamers  HYPERLINK \l "_ENREF_56" \o "Brus, 2012 #51"  ADDIN EN.CITE <EndNote><Cite><Author>Brus</Author><Year>2012</Year><RecNum>51</RecNum><DisplayText><style face="superscript">56</style></DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="dxret5s2ad2ra8erswtpdev8055faztz9p0t">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brus, Anne</author></authors></contributors><titles><title>A young people&apos;s perspective on computer game addiction</title><secondary-title>Addiction Research &amp; Theory</secondary-title></titles><periodical><full-title>Addiction Research &amp; Theory</full-title></periodical><pages>1-11</pages><dates><year>2012</year><pub-dates><date>2012/10/29/</date></pub-dates></dates><isbn>1606-6359, 1476-7392</isbn><urls><related-urls><url>http://informahealthcare.com/doi/abs/10.3109/16066359.2012.733466</url><url>files/841/16066359.2012.html</url></related-urls></urls><electronic-resource-num>10.3109/16066359.2012.733466</electronic-resource-num><remote-database-provider>CrossRef</remote-database-provider><access-date>2013/04/15/09:05:51</access-date></record></Cite></EndNote>56.

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�Game use�TotalRare or non-gamersNon-problematic gamersPolythetic gamersMonothetic gamersTotal -44.9%43.2%9.6%2.3%Mental, social, physical factors    Depression (0-50)7.02 (7.16)5.79 (6.82)7.23 (6.38)10.51 (8.68)12.33 (11.77)   Mental health (0-100)47.38 (9.07)48.86 (8.55)46.97 (8.93)43.33 (9.98)43.83 (10.36)   Physical health (0-100)53.07 (6.30)53.35 (6.08)53.23 (6.23)51.75 (7.09)50.05 (6.87)   Social consequences, sum-score (0-1)0.23 (0.20)0.21 (0.19)0.24 (0.20)0.29 (0.21)0.31 (0.26)   Health consequences, sum-score (0-1)0.19 (0.22)0.18 (0.25)0.19 (0.22)0.21 (0.22)0.22 (0.25)Substance use and dependence   Drug used, sum-score (0-18)1.97 (1.61)1.95 (1.61)1.97 (1.54)1.93 (1.53)2.35 (2.95)   Alcohol dependence (0-7)0.11 (0.17)0.10 (0.16)0.12 (0.17)0.13 (0.18)0.18 (0.28)   Problematic cannabis use (0-40)1.91 (4.67)1.69 (4.33)2.06 (4.77)2.04 (4.74)2.71 (7.63)   Gambling, sum score (0-7)0.29 (0.80)�0.24 (0.71)0.30 (0.75)0.39 (0.92)�0.82 (1.93)�Table 1. Descriptive statistics for the classification of the gamers and other variables
Remark: items range, means and standard deviation are given for each variable.


Paired comparisons (t-test)�Rare or non-gamers v.s. non-problematic gamersNon-problematic gamers v.s.            polythetic gamersPolythetic gamers v.s. monothetic gamersMental, social, physical factors Depression7.29***9.89***2.66**Mental health-7.52***-8.61***-0.57Physical health-0.67-4.98***-2.77**Social consequences, sum-score6.14***5.36***0.92Health consequences, sum-score1.561.600.44Substance use and dependenceDrug used, sum-score0.48-0.462.63**Alcohol dependence4.63***1.272.66***Problematic cannabis use2.83**-0.071.45Gambling, sum score2.85**2.39*5.45***�Table 2. Differences between classes of gamers on health, social, physical factors and consequences
Remark: the following contrasts were used: contrast 1: rare or non-gamers = non-problematic gamers; contrast 2: non-problematic gamers = excessive gamers; contrast 3: excessive gamers = pathological gamers. T-test values are given.
* p < .05; ** p < .01; *** p < .001.



ModelBICABICAICLMR p-valueOne-class8237.1982472.1882375.19-Two-class73023.0072841.8772644.42.000Three-class71173.4970900.2170602.31.000Four-class70419.7170054.2869655.92.000Five-class70209.2569751.6669252.84.282Six-class�70080.7469531.0069931.72.766�Table 3. Comparisons of different LCA models


Class 1Class 2Class 3Class 4��N = 918; 16.2%N = 292; 
5.2%N = 2,344; 41.4%N = 2,109; 37.2%Thought all day long about gamingNever0.110.020.340.88Rarely0.330.070.3680.10Sometimes0.350.100.2030.01Often0.180.290.0630.00Very often0.040.520.0250.00Longer game use than intendedNever0.050.050.1440.77Rarely0.160.020.2830.19Sometimes0.390.080.410.04Often0.350.260.1420.00Very often0.050.600.0210.00Use to forget about real lifeNever0.180.120.5460.94B\^_`o������h	�	�	�	�	[
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Remarks: Results are presented in probability scale.









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