The Harmful Dysfunction Analysis applied to the concept of behavioral addiction: A secondary analysis of data from the Health Behaviour in School-aged Children 2018

Objective: The study's principal aim was to explore the usefulness of the Harmful Dysfunction Analysis (HDA) in identifying individuals with pathological social media use (PSMU) and potentially other behavioral addictions as an alternative to using DSM-5-TR-based diagnostic criteria for substance use disorders (SUD) or research criteria for internet gaming disorder (GD).Method: Using Swiss data (N = 7,510) from the Health Behaviour in School-aged Children Study 2018, we tested weaker (HDA1) and stronger (HDA2) HDA versions. We examined differences between HDA cases and non-cases, convergence between different scoring methods, and between groups differences distinct to each scoring method (i.e., non-overlapping cases) on measures of physical health (physical activity and body mass index) and mental health (psychosomatic health, life satisfaction, school well-being), with models adjusted for age, gender, migration status, and family affluence. Data from Hungary (N = 3,789) was selected to repeat the analysis as a sensitivity investigation. Results: SUD-based scoring yielded the highest PSMU prevalence of 33.2% while GD-based prevalence was 9%. HDA1 and HDA2 scorings yielded PSMU prevalence of 22.2% and 4.2%, respectively. HDA1-based PSMU cases showed poorer physical and mental health than non-cases with differences of small-to-medium effect size, whereas HDA2 differences were of large effect size. SUD-based cases that overlapped with HDA scoring showed worse physical and mental health than non-overlapping SUD-based cases. Non-overlapping GD and HDA cases showed no significant differences on validators that survived the sensitivity evaluation. Conclusions: HDA may reduce PSMU prevalence while preserving conceptual and clinical validity. The more demanding HDA2 approach exhibited more convincing validator results than HDA1. From the HDA perspective, substantial SUD-based cases were false positives whereas GD-based scoring produced both false positives and negatives. Our findings suggest that further examination of HDA for advancing the conceptualization of addictive disorders is warranted.