A mother finds her once-engaged and loving son involved in excessive gaming. He starts failing classes and turns hostile toward his parents. His personality is transformed. This scenario is all too common. Gaming has been associated with the risk of developing addiction, depression, and aggression. Although the diagnosis of Internet Gaming Disorder (IGD) was entered into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used by clinicians and researchers to diagnose and classify mental disorders, in 2013, it has not been formally accepted in the United States – only in China, South Korea, and Japan.
In early 2018, the World Health Organization (WHO) made a decision to include IGD in the International Classification of Diseases (ICD) and in mid-2018 added the diagnosis to the ICD-11, which is the latest revision. But the DSM-5 to has yet to include the formal diagnosis. The inclusion by the WHO is based on the reviews of available evidence and the expert opinions gathered from individuals in different disciplines and geographic locations.
Defining IGD and gaming disorder
As defined in the ICD-11, IGD is a pattern of gaming behavior (digital or video) characterized by impaired control over gaming behaviors, giving increasing priority to the number of hours devoted to gaming, while ignoring other typical and customary day-to-day life activities. The gaming begins to take precedence over all other interests and activities, escalating despite obvious negative consequences.
With the advent of treatment programs devoted to helping people with this behavior pattern, and the presentation of people all over the world with similar characteristics of this gaming disorder, the WHO felt it was time to incorporate this into the 11th revision of ICD.
But what is the difference between a bad behavior and a disorder, and where do you draw the line?
How gaming becomes an addiction
When video games first became available in the 1970s, the games were simple and initially only available at arcades which had limited hours. Today’s versions are part of the framework of social network sites, and offer elaborate features, alternative worlds, complicated storylines, and multiple characters that draw the user in. They can also be accessed at all hours. Introverted or shy kids and teens can find interacting with a video game a lot easier than socializing with peers – and they can excel at this sport. In tandem with other gaming “geeks,” they feel powerful and empowered.
If a child or teen does have a problem, it can be disastrous, affecting school performance, homelife, moods, and social interactions.
A formal addiction or not
When we think of an addiction we readily recognize alcohol, drugs, gambling, smoking, and more recently “feeding” (obesity). Some experts say, compared to the number of people in the world, those who play these games (in the hundreds of millions) are mostly able to manage their habit. If you consider the number of individuals who fall into the category of “dangerous playtime,” in excess of 24 hours straight, the numbers are still quite small.On the other hand, a growing number of experts suggest that video game addiction could be classified as a type of impulse control disorder, and it should be assigned a formal diagnosis.
Thanks to high-resolution scans, we can now recognize the impact of IGD in certain brain regions, and see how brains of persons with gaming addiction differ from those without.
A June 2018 study on individuals who were suspected to have IGD showed “significantly decreased cortical thickness in the left lateral orbitofrontal cortex, inferior parietal lobule, bilateral cuneus, precentral gyrus, and right middle temporal gyrus.”
Criteria for defining an addiction
The American Society of Addiction Medicine defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” The dysfunction in these circuits leads to “characteristic biological, psychological, social and spiritual manifestations,” which is demonstrated by the person pathologically pursuing reward or relief by substance use and other behaviors.
Addiction is characterized by:
- The inability to consistently abstain
- An impairment in behavioral control
- A diminished recognition of significant problems with one’s behaviors and interpersonal relationships
- A dysfunctional emotional response.
Psychological and physical signs of video gaming addiction
Some of the psychological signs of video gaming addiction include:
- A noticeable drop of interest in school
- Anger and frustration when the individual is told they need to stop playing
- Feeling depressed when not actively engaged in gaming
- Always thinking about the next gaming session
- Feeling more peaceful and calm, or feeling euphoria when playing
- Loss of interest in previous hobbies or activities that provided pleasure
- Excessive frustration when the online server goes down
- Distorted sense of time when playing – you think you’ve only played for an hour, when in fact, you’ve played for half a day or more.
- Difficulty abstaining for more than several days.
Physical indications of gaming addiction include:
- Changes in sleep patterns
- Decreased personal hygiene
- Poor, irregular eating habits (weight gain or weight loss)
- Dry or red eyes
- Sore fingers, wrists, or neck
- Carpal tunnel syndrome
Treatment options for IGD
An April 2018 study suggests that the antidepressant bupropion may help some individuals. The drug has also been used in smoking cessation programs. Other approaches that are currently being used include in-patient intervention programs, wilderness therapy, traditional one-on-one counseling therapy, and family therapy. There are also some self-help books on the subject.
Adult gaming addiction can be concerning to a spouse or loved one. But kids and teens are especially vulnerable. Parents
can help to limit this risk by framing video game time as a treat with limits. Homework should always be completed first before gaming time. Other hobbies, sports activities, and outside-school hobbies should be given equal time to gaming time in order to balance out time commitments. If the individual begins to lie about time spent or bargains for more time repeatedly, or begins to literally “check out,” it is time to seek the help of a mental health professional to assess the situation.
Remember that someone with an addiction may not want help. Find a therapist who has experience with this new type of behavior or addiction. It also helps if parents or family members are all on the same page so that the individual does not get mixed messages.
The goal of identifying a gaming addiction, or even the risk that this behavior is developing, is to intercept at the earliest possible window of opportunity. Eventually, your loved one (or you) will recognize that help was indeed needed.