Prevalence and Risk Factors of Video Game Dependency in Adolescence: Results of a German Nationwide Survey Florian Rehbein, Grad. Psych., Matthias Kleimann, Grad. Mediasci., and Thomas Mo ¨ ßle, Ph.D. Abstract In this article, results of a German nationwide survey (KFN schools survey 2007=2008) are presented. The controlled sample of 44,610 male and female ninth-graders was carried out in 2007 and 2008 by the Crimin- ological Research Institute of Lower Saxony (KFN). According to a newly developed screening instrument (KFN- CSAS-II), which was presented to every third juvenile participant (N ¼ 15,168), 3% of the male and 0.3% of the female students are diagnosed as dependent on video games. The data indicate a clear dividing line between extensive gaming and video game dependency (VGD) as a clinically relevant phenomenon. VGD is accompa- nied by increased levels of psychological and social stress in the form of lower school achievement, increased truancy, reduced sleep time, limited leisure activities, and increased thoughts of committing suicide. In addition, it becomes evident that personal risk factors are crucial for VGD. The findings indicate the necessity of additional research as well as the respective measures in the field of health care policies. Introduction W hile TV usage time could be observed to be fairly consistent in almost all age groups in the past decade, 1 the relevance of interactive entertainment media as leisure- time activity has grown considerably both for youths and adults. In Germany, for example, computer ownership among adolescents ages 12 to 19 increased from 35% to 71% from 1998 to 2008, and ownership of gaming consoles increased from 23% to 45%. The availability of Internet access in ado- lescents’ bedrooms rose from roughly 10% in 1998 to 51% in 2008. 2,3 Recently, the issue of extensive video game (the term video games is used for both video and computer games in this article) behavior has gained further attention in research and clinical practice. 4–8 Young 9 specified a wide range of poten- tially addictive phenomena, such as cybersexual addiction, cyberrelational addiction, Net compulsions, information overload, and computer addiction. Subsequently, frequent attempts to explore these phenomena on an aggregated level called computer-related addictive behavior, 10 Internet addic- tion, or compulsive Internet use 11,12 are observed. However, due to the richness of different computer- and Internet- related activities, these terms could be criticized as not being precisely operationalized. 7 To date there has been little em- pirical insight into these diverse kinds of problematic media use behaviors and a subsumption under one medical cate- gory could prove premature. With video game dependency (VGD), we focused our re- search efforts on a clinical phenomenon currently reported to be notably widespread among computer-related problematic behaviors. 8 Video games can satisfying a wide number of in- dividual psychological needs and, because of their interactive structures, give rise to an intense experience of gratification in the user. 13,14 In sophisticated games such as massively mul- tiplayer online role-playing games (MMORPGs), players can regularly acquire or obtain points, placements on ranking lists, pieces of virtual equipment, new abilities, and oppor- tunities to configure their own avatar. The allocation of these rewards frequently follows a pattern of intermittent rein- forcement to the effect that the placing and magnitude of rewards are rarely predictable. 5 According to learning psy- chology, reinforcement schedules of this kind generate the highest response rates as well as the highest resistance to extinction 15 and therefore particularly promote an excessively rewarding behavior. Hence, video games in their very con- ception show a structural similarity to gambling and, as a consequence, are suspected of bearing a similar psychotropic dependency risk for some people. 16 The distinctive mechanisms, however, involved in binding certain players to certain virtual worlds are roughly system- atized and barely understood in detail to date. Different risk Criminological Research Institute of Lower Saxony (KFN), Hanover, Germany. CYBERPSYCHOLOGY,BEHAVIOR, AND SOCIAL NETWORKING Volume 13, Number 0, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089=cpb.2009.0227 1