The Issue

Video games, computers, social media, and the Internet are regular parts of our daily lives. For most people, this media use is integrated into their lives in a balanced and healthy manner. For others, time spent on the computer or video game is out of balance, and causes disruptions to work, school, friends, and family.

But is this really an addiction?

I began studying this issue in 1999 because I was highly skeptical of people using the term “addiction” to talk about computer or game use. I felt that parents only meant “My kid plays a lot, and I don’t understand why.” Spending a lot of time doing something is not a proper way to diagnose an addiction. For example, many people drink alcohol a lot but are not addicted to it.

To be an addiction means that addicts do something in such a way that it damages their ability to function in life. It also means that they must damage their functioning in multiple areas of their lives, not just one or two. They need to be damaging their social functioning, their occupational functioning, their family functioning, their school functioning, and/or their psychological or emotional functioning. Sadly, even when we take this conservative approach to defining it, it turns out that 8.5% of American youth gamers would classify as pathological or “addicted” (Gentile, 2009). Interestingly, this percentage seems to be about the same in the US as in many other countries where it has been studied, including 10.3% in China (Peng & Li, 2009), 8.0% in Australia (Porter, Starcevic, Berle, & Fenech, 2010), 11.9% in Germany (Grüsser, Thalemann, & Griffiths, 2007), 8.7% in Singapore (Choo, Gentile, Sim, Li, Khoo, & Liau, 2010), and 7.5% in Taiwan (Ko, Yen, Yen, Lin, & Yang, 2007).

One study followed over 3000 children for three years, and we found some surprising results.

• Of those who were pathological gamers at the start of the study, 84% of them still were pathological gamers 2 years later. This means that it isn’t just a phase children go through and get out of easily.

• When looking for risk factors predicting who would become a pathological gamer, we found that children who were more impulsive, had lower social competence, and spent more than the average amount of timing predicted who became pathological (or “addicted” if you prefer).

• When looking at outcomes, we were surprised to see that other psychiatric disorders such as depression, social phobias, and anxiety seemed to act as if they followed the gaming problems, rather than the other way around. That is, when children became pathological gamers, their depression, social phobias, anxiety, and grades got worse. When children stopped being pathological gamers, their depression, social phobias, and anxiety improved. Now we don’t know exactly what the causal processes are, but that probably isn’t the important issue. The important issue we can take away from this pattern is that gaming doesn’t seem to be simply a symptom of other problems, and therefore should not be ignored as if it is epiphenomenal. It is likely that pathological gaming is comorbid with other problems, where they can each reinforce each other in a downward spiral.

The APA included Internet Gaming Disorder in the appendix of the DSM-5 with the goal of stimulating more research on the issue. They were successful. Over 400 peer-reviewed studies were published in the 5 years after the DSM-5. Based partly on this additional empirical data and an international consensus of clinical experts, the World Health Organization included Gaming Disorder in the International Classification of Diseases – Version 11 (WHO, 2018). Their definition is consistent with prior definitions:

“1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context);

2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and
3) continuation or escalation of gaming despite the occurrence of negative consequences.
The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

It is perhaps significant that the WHO did not continue to use the modifier “Internet,” but focused specifically on gaming (which is also the core part of the DSM definition), regardless of whether it is Internet-connected.

What are the warning signs?

There is (as of yet) no agreed-upon set of risk factors, because the research has not yet identified them clearly. I therefore offer these symptoms as a general guide.

Symptoms of computer or video game addiction:

For children:

• • • Most of non-school hours are spent on the computer or playing video games.
    • Not keeping up with assignments.
    • Worsening grades.
    • Lying about computer or video game use.
    • Choosing to use the computer or play video games, rather than to see friends.
    • Changing friends to only those who also game.
    • Dropping out of other social groups (clubs or sports).
    • Irritable when not playing a video game or on the computer.
    • Falling asleep in school.
    • Aggressive responding when you try to stop their play.

For adults:

• • • Computer or video game use is characterized by intense feelings of pleasure and guilt.
    • Obsessing and preoccupied about being on the computer, even when not connected.
    • Hours playing video games or on the computer increasing, seriously disrupting family, social or even work life.
    • Lying about computer or video game use.
    • Experience feelings of withdrawal, anger, or depression when not on the computer or involved with their video game.
    • May incur large phone or credit bills for online services.
    • Can’t control computer or video game use.
    • Fantasy life on-line replaces emotional life with partner.

There are even physical symptoms that may point to addiction:

• Sleep disturbances
• Back, neck aches
• Headaches
• Failure to eat regularly or neglect personal hygiene

For the computer or video game addicted person, a fantasy world on-line or in a game has partially replaced his or her real world, certainly in terms of time spent in various activities. The virtual reality of the computer or game is more inviting than the everyday world of family, school or work. With the increased access to pornography on the Internet and in games, this fantasy world may be highly sexual.

What is the theory?

There are many different approaches to defining addictions. Nonetheless, they tend to share many characteristics. Brown (1991) summarized six core facets for the presence of addiction, and these are often similar across different approaches. Brown’s facets are salience (the activity dominates the person’s life, either cognitively or behaviorally), euphoria/relief (the activity provides a ‘high’), tolerance (greater activity is needed to achieve the same ‘high’), withdrawal symptoms (the experience of unpleasant physical effects or negative emotions when unable to engage in the activity), conflict (the activity leads to conflict with others, work, or the self), and relapse and reinstatement (the activity is continued despite attempts to abstain from it).

The DSM-5 suggested nine criteria that should be used to identify possible Gaming Disorder individuals (APA, 2013). Together they comprise a bio-social-psychological perspective by including symptoms at several levels of analysis. A total of five or more of each of these criteria must be met within a 12-month period before classification of Gaming Disorder can be considered. These criteria are listed below (how they fit with Brown’s classification system is also included).

• 1. Preoccupation with games. (The individual thinks about previous gaming activity or anticipates playing the next game; Gaming becomes the dominant activity in daily life. Salience)
• 2. Withdrawal symptoms when gaming is taken away. (These symptoms are typically described as irritability, anxiety, or sadness, but without physical signs of pharmacological withdrawal. Withdrawal)
• 3. Tolerance – the need to spend increasing amounts of time engaged in games. (Tolerance)
• 4. Unsuccessful attempts to control the participation in games. (Loss of control/ Relapse and reinstatement)
• 5. Loss of interest in previous hobbies and entertainment as a result of, and with the exception of, Internet games. (Conflict: damage to other important areas of life)
• 6. Continued excessive use of games despite knowledge of psychosocial problems. (Conflict: continuing despite awareness of problems)
• 7. Has deceived family members, therapists, or others regarding the amount of Internet gaming. (Conflict: antisocial behavior that damages relationships)
• 8. Use of games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety; Euphoria/relief).
• 9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in games. (Conflict: damage to other important areas of life)

People are classified as having gaming disorder if they exhibit at least five of the nine symptoms. Although pathological gamblers as a group show these symptoms, any individual is only likely to present a subset of them, and each individual may present a different subset. For detailed discussions regarding the conceptualization and expert assessment of these criteria see the following: Griffiths et al., 2016; Petry et al., 2014a, b; Petry et al., 2016.

What kind of a disorder is this?

My opinion is that it is an impulse-control disorder. That is, the gamer knows he should do his homework, but he can’t stop the impulse to keep playing…. This means that it’s not something about the games that is “addictive,” but instead that the person has allowed his/her computer or game habit to get out of balance with the rest of life.

Why are games and the Internet so fascinating that they could be a problem?

One way to think about it is to understand what leads to intrinsic motivations. One theory about human motivation is Self-Determination Theory, which argues that three basic needs lead to human motivation. These needs are the need for autonomy (we want to feel like we are in charge of what we are doing), the need for relatedness (we want to feel connected to other people), and the need for competence (we want to feel like we are good at things). The Internet and video games are excellent at satisfying these needs, and are therefore highly motivating. Compare that with how people often feel about their school or work, and you can immediately see why people might let things get out of balance.

What can be done?

Because pathological gaming or Internet use are not yet recognized by the American Psychiatric Association as a medical disorder, very few therapists know about it or how to treat it. (It is highly likely to be included as a bona fide mental health disorder when the DSM-6 is finalized.) I am not a clinical psychologist and cannot recommend a treatment plan. I do believe, however, that it is possible to treat. If you or a loved one is having problems keeping the computer or games in balance with the rest of daily life, I would recommend seeking a local counselor who has experience treating impulse control disorders, or perhaps one who has experience with chemical dependency disorders. I would also recommend taking a copy of my paper along to the first meeting, as a way of helping the therapist to understand what the issue is that concerns you (I often hear from people saying that they have been told by a therapist that there it isn’t a “real” issue, so you may need to help educate them about why they should take it seriously.)

You should recognize that trying to help your child may mean large changes to your family patterns. The adults have probably gotten very used to having lots of free time because the kids entertain themselves with the games. If you limit the games, you will need to replace them with something. This means being actively involved with your child in a way you may not have had to in a long time.

One way to think about it is to consider what needs of theirs are being met by games? Is it their sense of independence and autonomy? Their social and belongingness needs? Their sense of competence? (It may be all three!) If you take away the games, what will you give them to help them meet those needs elsewhere?

There are some places that claim to specialize in treatment for computer and game addiction. I do not know any details about these places and am only providing links here for your information – I am not specifically recommending them as I do not know how effective their programs are.

http://techaddiction.ca/

http://www.netaddictionrecovery.com/

Links to other resources

http://www.webmd.com/mental-health/features/video-game-addiction-no-fun

http://www.parentingscience.com/video-game-addiction.html

http://www.video-game-addiction.org/

http://www.springerlink.com/content/46737751h814h306/

http://www.time.com/time/health/article/0,8599,1925468,00.html