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Neuroimage Clin. 2017 Mar 29;14:741-749. doi: 10.1016/j.nicl.2017.03.010. eCollection 2017.

Dissociable neural processes during risky decision-making in individuals with Internet-gaming disorder.

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Institute of Developmental Psychology, Beijing Normal University, Beijing 100875, China.
State Key Laboratory of Cognitive Neuroscience, Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.
Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.
Departments of Psychiatry and Neuroscience, the Child Study Center, the National Center on Addiction and Substance Abuse, Yale University School of Medicine, New Haven, CT 06519, USA.
Connecticut Mental Health Center, New Haven, CT 06519, USA.
Students Counseling Center, Beijing Normal University, Beijing 100875, China.


Risk-taking is purported to be central to addictive behaviors. However, for Internet gaming disorder (IGD), a condition conceptualized as a behavioral addiction, the neural processes underlying impaired decision-making (risk evaluation and outcome processing) related to gains and losses have not been systematically investigated. Forty-one males with IGD and 27 healthy comparison (HC) male participants were recruited, and the cups task was used to identify neural processes associated with gain- and loss-related risk- and outcome-processing in IGD. During risk evaluation, the IGD group, compared to the HC participants, showed weaker modulation for experienced risk within the bilateral dorsolateral prefrontal cortex (DLPFC) (t = - 4.07; t = - 3.94; PFWE  < 0.05) and inferior parietal lobule (IPL) (t = - 4.08; t = - 4.08; PFWE  < 0.05) for potential losses. The modulation of the left DLPFC and bilateral IPL activation were negatively related to addiction severity within the IGD group (r = - 0.55; r = - 0.61; r = - 0.51; PFWE  < 0.05). During outcome processing, the IGD group presented greater responses for the experienced reward within the ventral striatum, ventromedial prefrontal cortex, and orbitofrontal cortex (OFC) (t = 5.04, PFWE  < 0.05) for potential gains, as compared to HC participants. Within the IGD group, the increased reward-related activity in the right OFC was positively associated with severity of IGD (r = 0.51, PFWE  < 0.05). These results provide a neurobiological foundation for decision-making deficits in individuals with IGD and suggest an imbalance between hypersensitivity for reward and weaker risk experience and self-control for loss. The findings suggest a biological mechanism for why individuals with IGD may persist in game-seeking behavior despite negative consequences, and treatment development strategies may focus on targeting these neural pathways in this population.


Internet gaming disorder; Outcome processing; Risk evaluation; Risky decision-making; fMRI

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