Internet gaming disorder: Microstructural brain alterations and their relation to functionally assessed correlates of reward processing, inhibitory control and the self-concept

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Accumulating case numbers of internet gaming disorder have moved the condition increasingly into the focus of clinical research within the past 10 years. Yet, adequate therapies and preventive measures, especially for adolescents, are still lacking. Given the high addictive potential of the condition, this proposal focuses on problematic usage of online role-playing games. These offer the simultaneous gaming of multiple users via their graphical agent (avatar) with or against each other in a virtual world. Similarities to substance addictions and pathological gambling point towards alterations in mesocorticolimbic reward processing- as well as prefrontal inhibitory control mechanisms. Diffusion Tensor Imaging (DTI) studies suggest an imbalance between the relatively early maturation of subcortical areas such as the striatum of the limbic reward system and retarded maturation processes in prefrontal control areas to be at the basis of adolescents increased vulnerability for addictive disorders. The early maturation of reward-associated brain regions might entail craving for immediate rewards and increase risk-taking, which cannot be counterbalanced by prefrontal inhibitory control mechanisms due to their delayed development. Seeing the high prevalence of young affected individuals, this explanatory model might also become essential for internet gaming disorder. Reward processing studies on internet gaming addicts showed increased striatal brain activations upon the perception of avatar- and virtual world-related images. The high salience of these cues might have its basis in the compensation of often observed self-concept deficits by an increased identification with the own avatar. Self-concept-related functional Magnetic Resonance Imaging (fMRI) studies suggest the involvement of a fronto-parietal network, e.g. composed of the medial prefrontal cortex (MPFC) as well as the parietal lobe including the Angular Gyrus (AG). Corresponding DTI studies on adolescents showed age-related white matter maturation processes in the superior longitudinal fasciculus, connecting fronto-parietal brain regions. A study of our own research group on online gaming addicts indicated an association of body-related self-concept deficits with AG hypoactivations. In contrast, AG hyperactivations positively correlated with the strength of identification with the own avatar. Connecting to previous research results, the present proposal aims to longitudinally assess the relation between microstructural (DTI) and functional (fMRI) measures investigating reward processing, inhibitory control as well as self-concept aspects in male adolescent and young adult internet gaming addicts.