Gaming addiction

DEFINITION: Gaming addiction broadly refers to excessive time playing games, particularly video games. Someone with a gaming addiction displays a pattern of behavioral addiction (similar to gambling addiction) whereby the person ignores social, relational, and occupational responsibilities and becomes preoccupied with the game. In general, gaming addiction has a greater connection to video games than to board games, card games, or sports.

ALSO KNOWN AS: Pathological video game use; problematic video gaming; video game addiction

Causes

Gaming addiction can have several underlying causes. In general, gaming addictions are triggered and cultivated when unmet (or partially met) social and psychological needs are fulfilled by playing games. It is believed that one of the primary functions of playing games is to rehearse real-life situations and circumstances to develop behavioral responses without risk. Reasons for excessive gaming can include stress release, relaxation, anxiety reduction, escapism, autonomy, social interaction, and competence and self-esteem development.

Gaming addiction is considered to be similar to pathological gambling in that it begins as rewarding entertainment. Video gaming, like gambling, activates the brain’s reward pathways (and releases dopamine). Another consideration in the cause of video game addiction is the genre of the game. The massively multiplayer online role-playing games (MMORPGs) have a significant mixture of social interaction and open-ended game play that has drawn considerable attention for being addictive. The interactive nature of video games and the increasing potential for realistic depictions of environments that allow for complex social interactions increase the potential that they become salient to the person playing the game.

Risk Factors

Research indicates that adolescent and young adult males are predominant users of video games and also show a greater incidence of dependency. Gaming can elicit a cognitive and affective state known as flow, which is characterized by a rewarding, focused sense of control and a loss of sense of time and place. Data demonstrate that pathological gaming can persist over time and is not a “phase.” Impulsivity, absence of empathy, low social competence, and inability to regulate emotion are correlated with pathological gaming, although experts differ on the causal relationship of these factors in gaming development. (The factors also may be in response to problematic gaming.)

Addictive or pathological patterns of gaming also appear to predict mental health issues such as depression, anxiety, and social phobias; however, the role of these effects in developing and maintaining gaming problems is unclear. Youth who play games more than thirty hours per week are more likely to develop gaming addiction than are those who game less than twenty hours per week. Games such as MMORPGs, which involve identifying with a gaming character or avatar, are much more likely to become addictive. Open-ended games or those that regularly add content to be mastered, also pose a risk of addiction. Persons with a history of addictions (such as substance abuse and gambling) and persons with extended periods of unstructured time are also considered to be at risk for gaming addiction.

Symptoms

Symptoms for gaming addiction, which range from psychological and social to physiological, include excessive game-binging (gaming for more than six to eight hours at a time with little or no interruption), gaming late into the night, a decreased interest in school or occupational pursuits, anger or frustration when denied access to gaming (for example, when the computer server is not working, when access to a game is denied, or when disengaging), being preoccupied with the next gaming session, downplaying the prevalence or effects of video gaming, a distorted perception of time while gaming, difficulty abstaining from gaming, increased spending on games and gaming platforms and equipment, and feelings of distress when unable to play. Relational symptoms include lying to others about how much time is spent gaming, decreased time spent with family and friends, increased preference given to fellow gamers in their social relationships, and decreased interest in marital and romantic relationships.

Other issues, such as sleeping difficulties or a significant change in sleep habits, dry or red eyes, weight gain, lack of attention to personal hygiene and eating habits, and soreness to the back, neck, hands, or wrists (such as carpal tunnel syndrome), can be symptomatic of pathological gaming. The use of substances such as stimulants (for example, caffeine) to aid in staying awake and alert also may indicate a gaming addiction.

Screening and Diagnosis

Several screening tools have been developed to study gaming addiction, none of which are considered gold standards. These screening tools use measures similar to those used to determine pathological gambling and substance abuse. The gaming addiction scale for adolescents is a Likert scale based on a series of questions that deal with what are suggested to be the core components of gaming addiction. These components include salience, tolerance, mood modification, withdrawal, relapse, conflict, and consequences or problems. Another screening tool is the problematic video game playing scale (PVP). The PVP is a nine-item forced-choice questionnaire that addresses issues related to symptoms of excessive gaming.

In general, proponents of including gaming addiction in the Diagnostic and Statistical Manual of Mental Disorders are concerned about the medical, educational, and social well-being of children who spend excessive time gaming. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), published in 2013, listed internet gaming disorder in the section of the manual that discusses conditions requiring further clinical research for consideration of inclusion as a formal disorder. In 2018, the World Health Organization (WHO) listed gaming addiction as a mental health condition for the first time in the draft of its 11th International Classification of Diseases (ICD-11). Some doctors argued that this move was premature, as the condition had not been thoroughly studied; in response, the WHO stated that it believed that classifying gaming addiction as a disorder would encourage further study and enable researchers to gather statistics more easily.

Gaming addiction can be considered comorbid with mood disorders, anxiety disorders, or antisocial disorders, as well as with other types of addiction. The symptoms, as outlined by the ICD-11, are similar to those of other addiction disorders, including impaired control over frequency, intensity, or duration of gaming; increased priority given to gaming; and continuation or escalation of gaming despite negative consequences.

Treatment and Therapy

The most commonly used treatments are individual psychotherapy and psychoeducation about the effects of gaming consumption. Interpersonal therapy and cognitive-behavioral therapy are commonly employed to treat comorbid psychological issues. In addition, support groups (such as Online Gamers Anonymous) and group therapy can be effective in treating gaming addiction, provided these groups consider matters of access, coping skills, relapse prevention, and recovery. Self-help and parenting books are also available to people who want to treat video game and other technology addictions.

Online communities for recovery also exist, although computer access and availability and the anonymous nature of this interface, which allows for viewing pornography, can be problematic. To address this, the use of filtering software to monitor use and prevent access to sexually explicit material is commonly regarded as a first-order behavioral or environmental intervention. Pharmacotherapy for gaming addiction or related diagnosis (such as anxiety disorder or mood disorder) should also be considered for severe cases.

South Korea has experienced a concerning increase in cases of internet gaming addiction, which has been evidenced by several deaths and murders linked to gaming addiction as well as the government's attempts to combat the addiction. In 2011, for example, the government passed a law that blocked youths under the age of sixteen from logging in to gaming websites between midnight and 6:00 a.m. Additionally, the country became the first to open treatment centers dedicated to helping people recover from gaming addictions as far back as the early 2000s. These centers focus on social interaction, outdoor activities, and hobbies such as arts and crafts. Such centers also exist in China, which has officially classified gaming addiction as a disorder since the early 2010s, and in Japan, players are alerted if they spend more than a certain amount of time each month on gaming.

Prevention

Prevention of gaming addictions is best achieved by avoiding the regular use of video games. Refraining from extended play of video games, especially MMORPGs and those that are open-ended, also is recommended.

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