Comorbid Attention Deficit Hyperactivity Disorder in Women with Premenstrual Dysphoric Disorder.

Background: This study evaluated the associations between inattention, impulsivity, and attention deficit hyperactivity disorder (ADHD) in women with premenstrual dysphoric disorder (PMDD) across the menstrual cycle. Methods: This study enrolled 58 women with PMDD and 50 controls. Symptoms were assessed using the Attention and Performance Self-Assessment Scale and the Dickman Impulsivity Inventory during the pre-ovulatory (PO), mid-luteal (ML), and late luteal (LL) phases of the menstrual cycle. Results: The chi-square analysis revealed a significant association between ADHD and PMDD. Women with PMDD experienced a greater increase in scores of prospective everyday memory problems and difficulties maintaining focused attention from the PO phase to LL phase than the controls; in addition, they had higher scores in dysfunctional impulsivity during the LL phase than the controls. Among women in the PMDD group, those with ADHD had higher scores in prospective everyday memory problems and dysfunctional impulsivity during the PO and ML phases than those without ADHD. Women in the PMDD group without ADHD had a greater increase in scores of prospective everyday memory problems, difficulties maintaining focused attention, and dysfunctional impulsivity from the PO phase to the LL phase than the controls. Conclusion: Our study demonstrated that women with PMDD were more likely to have comorbid ADHD and higher levels of inattention across the menstrual cycle. PMDD was associated with increased impulsivity during the LL phase, independent of ADHD, but it was not associated with a persistent elevation of impulsivity. Furthermore, PMDD women with comorbid ADHD experienced higher inattention and impulsivity during the PO and ML phases than those without it. Thus, ADHD comorbidity should be assessed when assessing or intervening in the symptoms of inattention and impulsivity in women with PMDD.

Estrogen, progesterone, cortisol, brain-derived neurotrophic factor, and vascular endothelial growth factor during the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder.

The interplay between ovarian hormones, stress, and inflammatory markers in developing premenstrual dysphoric disorder (PMDD) remains inadequately understood. This study investigated the associations of dynamic changes in the levels of estrogen, progesterone, cortisol, brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) with PMDD during the luteal phase of the menstrual cycle. A total of 58 women with PMDD and 50 healthy women were recruited in this study. These women's estrogen, progesterone, cortisol, BDNF, and VEGF levels were evaluated during the preovulation (PO), mid-luteal (ML), and late-luteal (LL) phases. Furthermore, the severity of P MDD symptoms, depressive symptoms, perceived stress, inattention, craving for sweet foods, and fatigue was assessed. The findings revealed that women with PMDD with higher levels of progesterone during the ML or LL phase or a greater increase (ML-PO) or higher sum (ML + LL) of luteal progesterone level exhibited a greater increase in PMDD symptoms during the luteal phase than did the healthy controls. Furthermore, women with PMDD exhibited higher cortisol levels during the LL phase than did the controls. The BDNF level was negatively correlated with PMDD severity. Furthermore, BDNF and VEGF levels were negatively correlated with inattention and craving for sweet foods among women with PMDD. These results suggest an association between progesterone and the exacerbation of PMDD symptoms during the LL phase. Women with PMDD have relatively high cortisol levels during the LL phase. Future investigations with experimental designs or larger sample sizes are warranted to verify the roles of progesterone and cortisol in the development of PMDD.

Heterogeneity of gaming disorder: A clinically-based typology for developing personalized interventions.

Background: The eleventh revision of the International Classification of Diseases (ICD-11) defines the three key diagnostic criteria for gaming disorder (GD). These are loss of control over gaming, gaming as a priority over daily activities, and impaired functioning due to gaming. While this definition has implications for the prevention and treatment of GD, there is significant heterogeneity in the symptoms and etiology of GD among individuals, which results in different treatment needs. Cognitive control, emotional regulation, and reward sensitivity are three critical dimensions in the etiology model for GD. Aspects such as gender, comorbidity, motivation for gaming, stage or severity of GD, and risk factors all contribute to the heterogeneity of etiology among individuals with the disorder. Method: On the basis of clinical symptoms and comorbidity characteristics among approximately 400 patients with gaming disorder, the present paper proposes a clinical typology of patients with GD based on the authors' clinical experience in treating individuals with GD. Results: The findings indicated three common types of patients with GD: (i) impulsive male patients with attention deficit hyperactivity disorder (ADHD), (ii) dysphoria patients with dysfunctional coping skills, and (iii) isolated patients with social anxiety. The paper also discusses the presentation and treatment priority for these patients. Conclusion: Personalized treatments for patients with GD should be developed to fit their individual needs. Future studies should examine the heterogeneity of GD and confirm these types, as well as obtain evidence-based information that can help in the development of personalized treatment. Treatment resources should be developed, and professionals should be trained to provide integrated individualized treatment.

Circadian typologies and insomnia in individuals with internet gaming disorder comorbid with attention deficit/hyperactivity disorder.

The alteration in circadian typology and insomnia were prevalent among both Individuals with IGD and those with attention deficit hyperactivity disorder (ADHD), the most comorbid psychiatric disorder of IGD. This study aimed to evaluate the relationships between circadian typologies, insomnia, and internet gaming disorder (IGD) and how ADHD affects this relationship. We recruited three groups of 69 young adults: an IGD group, a control group comprising age- and sex-matched nongamers, and a group of gamers without IGD through diagnostic interviews. The participants with IGD exhibited lower composite scale of morningness (CSM) scores and thus a higher eveningness preference In addition, the score of Pittsburgh insomnia rating scale-20-item version (PIRS_20) was significantly higher among those with IGD. The participants with IGD and ADHD exhibited lower CSM scores but higher PRIS_20 scores than the participants with IGD but without ADHD. The present findings indicate that participants with IGD exhibited a tendency of eveningness preference and experienced more severe insomnia. ADHD exacerbated the eveningness preference and insomnia of individuals with IGD. Close attention should be paid to sleep problems in individuals with IGD, particularly to those with ADHD.

Attention, response inhibition, impulsivity, and decision-making within luteal phase in women with premenstrual dysphoric disorder.

Cognitive impairment is a key feature of depressive disorder. Various forms of cognitive function have yet to be investigated in women with premenstrual dysphoric disorder (PMDD) during early luteal (EL) and late luteal (LL) phases. Therefore, we evaluated response inhibition and attention in PMDD in these two phases. We also examined the associations between cognitive functions, impulsivity, decision-making style, and irritability. There is a total of 63 female participants with PMDD and 53 controls, as determined through psychiatric diagnostic interviewing and a weekly symptoms checklist. The participants completed a Go/No-go task, Dickman's impulsivity inventory, Preference for Intuition and Deliberation scale, and the Buss-Durkee Hostility Inventory: Chinese Version-Short Form at the EL and LL phases. The women with PMDD had poorer attention in the Go trials at the LL phase and poorer response inhibition in the No-go trials at the EL and LL phases. Repeated measures analysis of variance revealed an LL exacerbation of deficit in attention among PMDD group. In addition, impulsivity negatively correlated with response inhibition at the LL phase. Preference for deliberation correlated with attention at the LL phase. Women with PMDD experienced LL declined attention and impaired response inhibition across the luteal phase. Response inhibition is linked to impulsivity. The deficit in attention links preference for deliberation among women with PMDD. These results reveal the different courses in different domains of cognitive impairment in PMDD. Further studies are required to elucidate the mechanism underlying cognitive dysfunction in PMDD.

Functional impairment, insight, and comparison between criteria for gaming disorder in the International Classification of Diseases, 11 Edition and internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Aim: This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated. Methods: We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS). Results: We observed satisfactory consistency (kappa value = 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%). Conclusion: There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment.

Screening, Brief Intervention, and Referral to Treatment Model Based on ICD-11 Criteria of Gaming Disorder and Hazardous Gaming During the COVID-19 Pandemic.

Purpose of Review: This commentary aimed to propose the screening, brief intervention, and referral to treatment (SBIRT) model for gaming disorder (GD) and hazardous gaming (HG) on the basis of the International Classification of Disease, 11th version (ICD-11) classification. Recent Findings: COVID-19 and its preventive measures increase the risk of GD and the treatment needs could exceed the capacities of mental health systems. Brief intervention could be provided for adolescents with HG after screening. Psychiatrists make diagnoses of GD or HG and then refer them to school counselors, specialized psychologists, or integrated teams based on the severity, comorbidity, and complication of GD. Summary: The classification of GD and HG was suitable to develop a SBIRT model intervention. The SBIRT should work through the shortage of resources and provide a brief intervention guild to make it practical.

Early and Late Luteal Executive Function, Cognitive and Somatic Symptoms, and Emotional Regulation of Women with Premenstrual Dysphoric Disorder.

OBJECTIVE: Cognitive and somatic symptoms were vital factors in developing personalized treatment of depressive disorder. The study aimed to evaluate the following: (1) the cognitive and somatic symptoms of premenstrual dysphoric disorder (PMDD) in the early luteal (EL) and later luteal (LL) phase; and (2) their association with depression and functional impairment of PMDD. METHODS: We prospectively evaluated executive function, emotion regulation, cognitive and somatic symptoms, and depression in the EL and LL phases in women with PMDD. Sixty-three women with PMDD and 53 healthy controls completed Simon's task and questionnaire to assess emotion regulation, inattention, fatigue, insomnia, and depression. RESULTS: Women with PMDD had a poor performance in Simon's task during the LL phase. They were less likely to exercise cognitive reappraisal during EL and LL phases. Their cognitive reappraisal positively correlated with executive function and negatively associated with depression. In the LL phase, they also experience higher inattention, insomnia, and fatigue, which correlate with the depression and functional impairment of PMDD. Inattention is the most associated factor of PMDD and functional impairment in controlling depression. CONCLUSION: Executive function was impaired in women with PMDD during the LL phase. Its performance correlated positively with emotion regulation and negatively with depression. The association between inattention and PMDD functional impairment indicates that evaluation and intervention for cognitive impairment were essential in treating women with PMDD. Further studies were required to elucidate the possible etiology underlying these associations.

The withdrawal-related affective, gaming urge, and anhedonia symptoms of internet gaming disorder during abstinence.

Aim: The study explores IGD withdrawal-related presentations, including autonomic reaction, affective symptoms, anhedonia, and gaming urge during abstinence from gaming. We prospectively evaluated these withdrawal-related symptoms (WRS) and gaming craving during abstinence from gaming. Methods: We examined 69 individuals with IGD and 69 regular gamers and evaluated their WRS (using an exploratory questionnaire), affective and behavioral WRS (using the Questionnaire on Gaming Urge-Brief Version gaming disorder questionnaire), and heart rate. All the participants attempted to abstain from gaming before our assessment. Subsequently, some participants' WRS and gaming craving before they engaged in gaming were prospectively evaluated. Results: In the IGD group, 85.5% experienced gaming WRS, including affective, anhedonia, and gaming urge symptoms. They could relieve these symptoms through gaming. The IGD group experienced more severe gaming WRS, gaming craving, and a higher heart rate than the regular gamer group. Gaming urge was most associated WRS of IGD. Participants with IGD experienced more severe gaming cravings when their gaming abstinence before the assessment was shorter. WRS attenuated at night and the following morning when they maintained their gaming abstinence after assessment. Conclusion: Individuals with IGD experience withdrawal-related affective, anhedonia, and gaming urge symptoms and a higher heart rate during abstinence. The WRS attenuated in 1 day. Most participants agreed that these symptoms could be relieved through gaming. Further prospective evaluation by objective assessment in an adequate sample was required to understand gaming withdrawal symptoms comprehensively.

Association between urbanization and Internet addiction.

PURPOSE OF REVIEW: Understanding the association between urbanization and Internet addiction is essential to the design and implementation of Internet addiction prevention measures in urban areas. This epidemiological review explores the urbanization-Internet addiction association and its potential underlying factors. RECENT FINDINGS: Nine studies have reported that Internet addiction prevalence is higher in urban areas, but three studies have noted the opposite. Psychiatric disorders and stress are the most commonly mentioned factors underlying the association. The effects of urbanization on Internet availability, Internet cafes, online gaming, outdoor or interactive activities, and family regulation and monitoring have been suggested to lead to higher Internet addiction risk. The ongoing COVID-19 pandemic, obesity, sleep problems, and the migration of parents to urban areas in search of work have strengthened the effect of urbanization on Internet addiction. SUMMARY: Early assessment and treatment provided by mental health services are crucial for mitigating the effect of urbanization on Internet addiction risk. Cities should be designed to provide adequate space for physical and interactive activities. To promote outdoor activities, air pollution, traffic congestion, and crime should be controlled. Prospective face-to-face studies involving analysis of data on pollution, traffic, and Internet addiction could provide evidence to elucidate the urbanization- Internet addiction association.

Association of Internet gaming disorder with catechol-O-methyltransferase: Role of impulsivity and fun-seeking.

Dopamine functioning is an essential mechanism underlying addictive behaviors. This paper evaluates the association of Internet gaming disorder (IGD) with the catechol-O-methyltransferase (COMT) val158met polymorphism and examines the roles of impulsivity and reinforcement sensitivity in this association. Using diagnostic interviews, this study recruited 69 participants with IGD and 138 participants without. All participants underwent diagnostic interviews for IGD and an evaluation for the COMT val158met polymorphism, impulsivity, and reinforcement sensitivity. Among participants with the Val/Val genotype, the odds ratio (95% confidence interval) for IGD was 2.09 (1.15-3.80). The IGD-Val/Val genotype association was mediated by impulsivity and fun-seeking. The Val/Val genotype is indicative of low frontal functioning and is a predictive factor of IGD, with this effect being confounded by impulsivity and fun-seeking. Interventions targeting impulsivity and fun-seeking might attenuate the risk of IGD, particularly among individuals with the Val/Val genotype. Additional studies are necessary to elucidate the possible role of dopamine functioning.

Roles of Hostility and Depression in the Association between the MAOA Gene Polymorphism and Internet Gaming Disorder.

The metabolism of bioamine in the central nervous system contributes to the development of addiction. We examined the roles of hostility and depression in the association between internet gaming disorder (IGD) and monoamine oxidase-A (MAOA) EcoRV polymorphism (rs1137070). A total of 69 adults with IGD and 138 without IGD were recruited through diagnostic interviewing. We evaluated participants for rs1137070, depression, and hostility. The participants with the TT genotype of rs1137070 had a higher odds ratio of 2.52 (1.37-4.64) for IGD compared with the C carriers. Expressive hostility behavior and hostility cognition mediated the association between rs1137070 and IGD. Indicating lower MAOA activity, the TT genotype predicted IGD and higher expressive hostility behavior and hostility cognition. Expressive hostility behavior and hostility cognition may underline the association between rs1137070 and IGD. Assessment of and intervention for hostility behavior and cognition should be provided to attenuate the risk of IGD, particularly in those with the TT genotype. Further brain imaging or neurobiological studies are required to elucidate the possible mechanism underlying the association between MAOA activity and IGD.

Insomnia, Inattention and Fatigue Symptoms of Women with Premenstrual Dysphoric Disorder.

AIM: Premenstrual dysphoric disorder (PMDD) has predictable, cyclic, psychological, and somatic symptoms, such as sleep problems. They result in functional impairment, are aggravated in the late luteal phase of the menstrual cycle, and are resolved by menstruation. The present study evaluated the insomnia, inattention, and fatigue symptoms of PMDD and their fluctuations during the menstrual cycle. METHODS: A total of 100 women were diagnosed as having PMDD based on psychiatric interviews and a prospective investigation of three menstrual cycles. A total of 96 individuals without PMDD were recruited as controls. Their symptoms, namely insomnia, inattention, and fatigue as well as functional impairment were assessed by using the premenstrual symptoms screening tool, the Pittsburgh insomnia rating scale, the attention and performance self-assessment scale, and the fatigue-assessment scale during both premenstrual and follicular phases. RESULTS: In both the premenstrual and follicular phases, women with PMDD experienced more severe insomnia, inattentiveness, and fatigue than did women in the control group. A paired t-test demonstrated that women with PMDD had more severe severity insomnia, inattentiveness, and fatigue in the luteal phase than in the follicular phase. A repeated-measures analysis of variance demonstrated that the interaction period of PMDD and a menstrual cycle was significantly associated with insomnia, inattentiveness, and fatigue. A further correlation analysis demonstrated that all three symptoms were positively associated with self-reported functional impairment due to PMDD. CONCLUSIONS: Our results demonstrated that women with PMDD experienced an exacerbation of insomnia, memory problems, difficulty maintaining focus, and fatigue in the premenstrual phase. These symptoms are correlated with PMDD symptoms severity and functional impairment, and as such, they should be evaluated, and interventions should be employed in the late luteal phase of women with PMDD.

The frustration intolerance of internet gaming disorder and its association with severity and depression.

This study aimed to evaluate the belief of frustration intolerance of individuals with internet gaming disorder (IGD) and its association with depression among them. We recruited 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers). IGD is diagnosed based on DSM-5 (DSM stands for diagnostic and statistical manual of mental disorders) criteria through psychiatric interviews. They had completed the questionnaire for the belief of frustration intolerance, depression, and severity of IGD. The participant with IGD had a higher score on the frustration discomfort scale and its subscales, discomfort intolerance, entitlement, emotional intolerance, and achievement. Further regression analysis demonstrated an independent association between entitlement and IGD in control of depression. The frustration intolerance is also associated with depression and the severity of IGD among the IGD group. The discomfort intolerance and achievement were the most associated factors of depression. Frustration intolerance is a crucial irrational belief of IGD. It contributes to the severity of IGD and depression among individuals with IGD. The frustration intolerance, particularly for discomfort intolerance, entitlement, and achievement, should be assessed and intervened while treating individuals with IGD.

Coping, Resilience, and Perceived Stress in Individuals with Internet Gaming Disorder in Taiwan.

AIM: Gaming escapism is an essential factor for developing internet gaming disorder (IGD). We evaluated coping strategies, resilience, stress, and depression in individuals with IGD. METHODS: We included 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers) in Taiwan. The self-reported coping strategies, coping stress with gaming, resilience, perceived stress, and depression were assessed. RESULTS: Participants with IGD had higher dysfunctional coping, coping stress by gaming, perceived stress, and depression, as well as lower problem-focused coping and resilience. Regression analysis revealed that coping by gaming was associated with dysfunctional coping mechanisms, particularly venting and self-distraction. Compared with participants with adequate resilience, those with lower resilience had higher perceived stress, depression, and coping by gaming, and lower problem-focused and emotion-focused coping. Dysfunctional coping and coping by gaming were associated with perceived stress and depression in both IGD and control groups. Problem-focused coping was negatively associated with perceived stress and depression in controls. CONCLUSION: Individuals with IGD had higher perceived stress and depression, as they were more likely to cope with stress by dysfunctional coping and gaming and less likely to try problem-focused coping, particularly those with lower resilience. Interventions for IGD should promote problem-focused coping, such as active coping and planning strategies, particularly among those with lower resilience.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria.

OBJECTIVE: In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them. METHODS: A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified. RESULTS: Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies. CONCLUSION: The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Impact of COVID-19 on gaming disorder: Monitoring and prevention.

The global coronavirus disease 2019 (COVID-19) outbreak has necessitated physical distancing, lockdown, contact tracing, and self-quarantine so as to prevent the spread of the disease. Amid the outbreak, gaming data usage has reportedly increased in the United States, and game download volume has reached a record high in Europe. Because gaming can be used to cope with the psychological stress from the outbreak, therefore mental health professionals should be aware of how increased gaming during the pandemic may contribute to risk of gaming disorder, especially if the pandemic persists. Mental health professionals should thus formulate safe social interaction alternatives for people, particularly adolescents, who have gaming disorder risk.

Leptin and ghrelin concentrations and eating behaviors during the early and late luteal phase in women with premenstrual dysphoric disorder.

OBJECTIVES: In this study, we evaluated the changes in leptin and ghrelin concentrations, eating behavior, depression, and impulsivity and their correlations within the luteal phase among women with premenstrual dysphoric disorder (PMDD). METHODS: In 63 women with PMDD and 53 healthy controls, we prospectively evaluated serum levels of leptin and ghrelin, Body Mass Index(BMI), and self-reported sweet cravings, cognitive restraint, uncontrolled eating, emotional eating, depression, and impulsivity during the early luteal (EL) and late luteal (LL) phases. RESULTS: Compared with the controls, the women with PMDD had higher BMI, higher leptin concentrations in the EL and LL phase, and leptin concentrations increased from the EL to the LL phase. However, there is no significant difference in ghrelin. Women with PMDD increased sweet cravings and uncontrolled eating from EL to LL phase. No significant correlation was observed between the EL-LL changes in leptin or ghrelin concentrations and those in eating behaviors. Both depression and impulsivity correlated with sweet craving and uncontrolled eating. Depression mediated the association between PMDD and uncontrolled eating. The BMI of women with PMDD positively correlated with their EL-LL change in leptin, and LL depression levels and emotional eating. CONCLUSION: Young women with PMDD had higher leptin concentrations and BMI in the luteal phase. The LL leptin level was not the primary factor responsible for the increased uncontrolled eating of PMDD. Whether the increased eating and depression in the LL phase contribute to the risk of obesity or hyperleptinemia among women with PMDD need to be evaluated in the future.

The association between Emotional Regulation and Internet Gaming Disorder.

PURPOSE: Lack of control over Internet gaming habits may result in negative consequences. This study aimed to evaluate the emotional regulation of adults with Internet gaming disorder (IGD) and the association of emotion regulation, depression, and hostility. METHODS: Advertisements were used to recruit 69 young adults with IGD, 69 sex- and age-matched controls, and 69 sex- and age-matched regular gamers. The diagnosis of IGD was according to diagnostic interviews based on DSM-5 IGD research criteria. Participants completed the Affective Style Questionnaire, the center of epidemiological studies depression scale and the short-form Chinese version of Buss-Durkee Hostility Inventory. RESULTS: In the IGD group, the emotion adjustment score was significantly lower, whereas the scores for depression, and hostility were significantly higher than in the other two groups. In addition, emotion adjustment is the most associated emotion regulation behavior of IGD, followed by emotion concealment. In IGD group, emotion adjustment had a negative correlation with depression and hostility. CONCLUSIONS: Our study demonstrate that emotion adjustment is significantly associated with IGD. The depression and hostility mediated the association. Knowing that emotion adjustment plays a critical role in IGD, future interventions should focus on this subscale of emotion regulation.