Is it real?
Most of us like to play video games at some point during our lives. For some, they outgrow this as they become an adult. For others, it’s activity that they continue to partake in as adults. The concern is whether or not gaming is addicting. Is gaming disorder a real thing? How do you know if you have a problem?
It doesn’t matter where you go or what you’re doing, if you look around you, you’ll see the majority of people engrossed in their phones. There’s no question that texting and social media are a large part of what people are doing, but there’s one thing that is gaining more and more of our attention—gaming. When you think of gaming, you probably think if teens and children. You’re not wrong because according to Pew research study, 97% of teen boys and 83% of girls play games on some kind of device. However, adults are gaming more now than ever before. One study estimates that around 160 million American adults play internet-based games. Per the Entertainment Software Association, at least one person plays video games in two-thirds of American households. It’s not just an American problem, but much more widespread. So much so that the South Korea and China governments have taken notice and start implementing policies to help reduce the amount of time people spend gaming. It shouldn’t come as a surprise that people like to play video games since they’re designed to keep you engaged for long periods of time. In some cases, video game developers employ psychologists to help create games that will appeal to people and use a technique called “schedules of reinforcement.” With gambling and gaming addictions, the reward happens intermittently and it’s unpredictable. So, you keep playing in order to get the good feeling that’s produced in the brain when you reach a new goal or successfully complete an objective., but with video games, especially massively multiplayer online role-playing games (MMORPGs), they’re designed to make you repeat behaviors in the search of that gaming high. The draw to stay connected can become irresistible. This high usage of games has resulted in many people referring to themselves being “addicted” to games, but is it truly an addiction?
The World Health Organization (WHO) released the 11th revision of the International Classification of Diseases (ICD-11) in mid-2018 and officially adopted it on May 25, 2019. In this revision, they included an entry on “gaming disorder” as a behavioral addiction. According to them, gaming disorder is defined as a pattern of gaming characterized by impaired control over it, prioritizing it over all other activities and continuation or escalation of use despite the occurrence of negative consequences. In order to be diagnosed with gaming disorder, the use of games must cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning for at least 12 months. It’s important to note that nowhere in the criteria does it mention anything about the number of hours that must be spent playing in order to be diagnosed. The WHO’s decision to include gaming disorder in ICD-11 is based on reviews of available evidence and a consensus of experts from different disciplines and geographical regions. According to these experts, people’s use of gaming is different from their use of the internet, social media, online gambling and online shopping. In listing gaming disorder in the ICD-11, the WHO has been careful not to use the label “addiction,” but used the term “disorders due to addictive behavior.” Their goal in incorporating gaming disorder in the ICD is to bring more attention to the issue and raise the visibility of treatments for those seeking help for excessive game playing. The inclusion comes at a time when public concern over technology abuse is increasing. A good example of this is that Apple and Google have both created tools designed to help users monitor and manage the time they spend staring at screens. Parents also have the option to implement restrictions on the time their kids spend playing games.
The WHO’s decision to add “gaming disorder” to the list of recognized diseases is definitely controversial amongst those in the scientific community. Current research involving several studies of adults in the US, United Kingdom, Canada and Germany found that more than 86% of adults ages 18 to 24 and over 65% of all adults had recently played online games. The split between men and women was roughly equal. According to the data collected, 0.3 – 1% of people who game are likely to qualify for a gaming disorder diagnosis. While this might seem low, when you consider the millions of people who game, that number could translate to millions of people. As a reference, the National Institutes of Mental Health states the occurrence of schizophrenia and related psychiatric disorders ranges 0.25 – 0.64% in the US. In addition, researchers did note that they were unable to determine whether those who met the criteria for internet gaming disorder had poorer emotional, physical and mental health than those who did not meet the criteria. This is why all researchers agree that there hasn’t been enough research on gaming behavior to classify it as a disorder. Many of the experts feel that the criteria used by the WHO is too similar to those used to describe any addictive behavior and isn’t specific enough to gaming. In the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the primary resource for identifying and diagnosing mental health disorders in the US, the American Psychiatric Association (APA) identified Internet Gaming Disorder as an area for further study, but did not officially add it as a disorder. The ICD-11, unlike the DSM, has no provisional categories where potential disorders are listed as requiring more research. The DSM includes substance-related addictive disorders, such as alcohol, tobacco, stimulants, marijuana and opioids. Gambling disorder is the only behavioral addiction, which would be the closest to gaming disorder. It’s important to note that without an official DSM code, it’s hard to bill insurance companies for treatment of a specific issue. One study published in American Journal of Psychiatry in March 2017 wanted to examine the validity and reliability of the criteria for internet gaming disorder as it was defined in the DSM and compare it to research on gambling addiction in order to estimate its impact on physical, social and mental health. The study’s results state that of those who game, most people don’t report any symptoms of internet gaming disorder, so the percentage of people that might qualify for internet gaming disorder is extremely small. On the other hand, a new study from the Oxford Internet Institute suggests that “gaming disorder” may not be a real at all. It was conducted on a group of 1,004 14- and 15-year-olds from the UK. The teens and their caregivers answered questionnaires about the teens’ gaming habits and how the kids function in daily life. The study determined that variations in gaming usage are linked to whether a teen’s basic psychological needs for competence, autonomy and social belonging are being met and whether they’re already having issues functioning daily. So, maybe the games aren’t the cause of the problem, but are an escape from the problem.
The WHO’s gaming disorder definition doesn’t provide any information about what kinds or features of games that might be addicting, which means that it’s too broad to be helpful and the evidence is inconsistent. When compared to other addictive substances, such as opiates and nicotine, we know how they work and what makes them addictive, but we don’t know this for gaming. This led a group of researchers to write a letter to the WHO in 2016 recommending not to add “gaming disorder” to the diagnostic handbook because they felt there isn’t a consensus within the scientific community and most studies in the area are low-quality. The researchers claim that since most of the previous studies rely collecting data from self-help or gaming forums where people post about being addicted to gaming and there are over 50 different self-report scales, we don’t have an accurate idea of how many people might have gaming disorder. For instance, some reports say that gaming disorder afflicts less than 1% of gamers, but others suggest rates up to 100 times higher, which is why estimates of the extent of gaming disorders vary considerably. One of the potential upsides of the WHO’s designation is that it might push researchers to do more open and rigorous studies and encourage gaming companies to be proactive by sharing the data they’ve collected.
Despite disagreeing about whether or not gaming disorder is real, most researchers are still concerned about some of the patterns of behavior they see. They definitely feel that people who game should be aware of how much time they spend on gaming activities, especially if it’s to the exclusion of other daily activities or if they have any changes in their physical/psychological health and social functioning. One clinician explained that there are people so caught up in gaming that they don’t even get up to use the bathroom. Each person needs to look at their own gaming habits as it relates to the full context of their life. Some helpful questions to ask yourself are: Is your preferred media activity the only thing that puts you in a good mood? Are you angry or otherwise unhappy when forced to unplug? Is your usage increasing over time? Do you try to conceal your gaming from others? Does it interfere with family activities, friendships or school/work? If you answer yes to most of the these questions or you’re having trouble controlling the amount of time that you spend playing games or prioritize gaming over other activities, you should seek help from a mental health professional.
Another important consideration is that gaming addiction may present with other disorders, like anxiety disorders, depression, ADHD and stress. Several studies have found that children who have problems with video games often diagnosis as having ADHD or being on the autism spectrum. In addition, young people who have problems with social media are more likely to be diagnosed with depression or anxiety. Due to the many hours playing games, these individuals have strong emotional attachment to gaming and may experience fewer social connections as a result. Children and teens are at the highest risk because they have greater difficulty judging the negative effects of gaming behavior since our brains don’t fully develop until were around 25 and the last part of our brain to completely develop is the part that is designed to help us make good decisions, better predict the outcome of our behaviors and gauge likely consequences more effectively. Despite it being more likely to occur in adolescents, addiction to gaming can happen at any age. Besides the mental health impact, it can have a significant impact on your physical health because if you remain physically inactive for extended periods of time, you have a higher risk of obesity, sleep problems and other health issues.
Since this is a new classification and not fully accepted yet, there isn’t a clear treatment plan. Most likely, treatments for other addictive behaviors will be relevant for gaming disorder, including therapy, medication, and self-help groups. For individuals who have issues with alcohol, drugs or gambling, even though it’s not easy, they can choose abstinence. However, for those who have problems with food, like binge eating or anorexia, they must rebuild their relationships with food while continuing to eat every day. Although complete abstinence from technology might be needed initially, given the world we live in, technology is more like food than any other addiction because most students need to use computers for school assignments, build tech skills for the workplace and learn to deal with distraction/procrastination. One of the most important parts of treatment is educating the person about how their gaming behavior is negatively affecting their mental health. The goal should be to help the person to control cravings, deal with irrational thoughts and learn coping skills and problem-solving techniques while discovering their identity, building self-esteem and boosting their emotional intelligence. It’s also key for the individual to learn interpersonal skills, such as how to interact with others by communicating effectively and assertively. Also, any coexisting conditions require treatment. Family counseling should focus on helping families implement techniques to reduce the amount of time spent gaming, like keeping devices out of the bedroom, making sure that children/teens go to school, spend time with friends and play outdoors. Very similar to other addictive behaviors, it’s often hard for individuals who’ve had problems with gaming to develop greater control over it.
Obviously, simply playing a lot of video games doesn’t mean that someone has an addiction problem. This is why the inclusion of gaming disorder has some researchers fearing that it’ll lead to large amounts of children being stigmatized for their video game playing. Many scientists argue that children could be misdiagnosed, particularly if worried parents mistake enthusiastic gaming for gaming disorder. Other researchers believe that it might be a real thing, but it’s definitely not the epidemic that it has been made out to be. When you label someone as an addict, you’re essentially saying that they have a chronic disease and this is an incredibly powerful statement, especially for teens, who are in the process of forming their identities. One thing is for certain that we don’t want people classified as having a mental health disorder when they don’t really have one. This is why clear diagnostic criteria is imperative.
At least, here in the US, addiction isn’t the official term, yet. Numerous experts have said that classifying excessive gaming as a disorder neglects to distinguish underlying causes and diminishes other, often more serious, forms of addiction. In light of all the information, or lack thereof, that is currently available, we should also consider the question: if excessive gaming is the symptom of another disorder, and isn’t the disease, do you still treat it as a gaming addiction? The bottom line is even if it’s not a disorder, it still needs to be addressed.