What is Video Game Addiction?
Video game addiction is a controversial term used to describe a condition observed in a minority of individuals playing video games, particularly Internet-based games, who display signs characteristic of addiction. A relatively recent phenomenon, reports of video game addiction have arisen in parallel with the exponential growth of gaming and internet culture during the past two decades.
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Despite such reports, problematic gaming remained unclassified as an official condition for more than 15 years. More recently, a body of literature that describes individuals with problematic preoccupations with playing video games, particularly online games, has emerged. Such individuals display behaviours that mirror other forms of recognised addiction; compulsive use to the detriment of other activities, clinically significant distress and decline in social and academic or work functioning. When restricted from participating in gaming activities, this group displays symptoms of withdrawal. The prevalence of problematic gaming in Europe and the US has been estimated to be between 1.5% and 8.2%.
More recent studies propose that being excessively engrossed by Internet games is associated with neurological and circulatory responses akin to those observed in drug addiction. Park et al. compared a group of young people deemed ‘Internet addicted’ to healthy controls, and found that the addicted group displayed a higher overall heart rate with less variation in rate than the control group. Zheng et al. reviewed 40 studies using whole-brain mapping and found evidence for the activation of the brain reward system when gaming, an established mechanism for substance addiction.
Increasing evidence for video game addiction culminated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5; American Psychiatric Association, 2013) considering ‘Internet Gaming Disorder’ (IGD) as a future diagnostic category. The most recent iteration of the international statistical classification of diseases and related health problems (ICD-11; World Health Organisation 2018) includes Gaming Disorder as a discrete category of disorder.
Symptoms and Diagnosis of Internet Gaming Disorder (IGD)
Although not recognised as a formal disorder, DSM-5 has classified IGD as a condition warranting further study, differentiated from Internet-based gambling behaviour, which is classified as a sub-type of Gambling Disorder. The suggested diagnostic criteria for IGD is summarised as “repetitive use of Internet-based games, often with other players, that leads to significant issues with functioning”. In order to meet the threshold for potential diagnosis, an individual must display five of the following nine symptoms during a one-year period:
- A preoccupation or obsession with playing Internet games,
- Experience of unpleasant symptoms when prevented from playing Internet games (withdrawal),
- The need to spend increasing amounts of time playing games (tolerance),
- Unsuccessful attempts to reduce or stop playing games,
- Loss of interest in previously enjoyable activities or hobbies as a result of gaming,
- Continuation of the overuse of Internet gaming, despite knowledge of the negative impacts upon functioning,
- Deceiving others regarding the extent of gaming,
- Relying on the use of Internet games to relieve anxiety, guilt or other negative emotions
- Jeopardizing or losing a relationship or academic or work opportunity because of participation in gaming.
Furthermore, the DSM includes three severity modifiers; mild, moderate and severe, which are based upon the amount of time spent Internet gaming and the overall impact upon functioning.
Criticisms of Diagnosis
Given the relative novelty of the condition, data regarding the etiology and clinical course of IGD is limited (Kuss et al. 2017). Critics have argued that clarification regarding the defining features of the disorder is still required, while the requirement that only five symptoms out of nine be present creates an overly heterogeneous diagnostic group. Further complicating the clinical picture is a high rate of co-morbidity between IGD and other disorders, most notably depression, anxiety, ADHD and OCD (Liu et al. 2018; Gonzalez-Bueso et al. 2018).
Current treatments for IGD have been developed from existing evidence-based interventions for substance abuse disorders. Interventions applied in clinical settings are either psychosocial or pharmacological.
Cognitive behavioural therapy (CBT) dominates psychosocial treatments for IGD and involves cognitive restructuring to modify destructive thought patterns, behaviour modification and harm reduction. Specific adaptations to CBT, known as CBT-IA (Young, 2011) to address problematic Internet use includes identifying and challenging maladaptive rationalizations regarding Internet use, identifying computer and non-computer activities to attempt to increase offline behaviour and identifying and minimising actions related to relapse.
Pharmacological treatments derive from the high degree of co-morbidity between IGD and other disorders, with antidepressant medication showing a reduction in time spent online and cravings to use the Internet.
However, the current availability of high quality research assessing the acceptability and effectiveness of interventions tailored for IGD is limited, and the diversity of psychosocial treatment modalities makes overall comparisons challenging. There remains a lack of consensus regarding the definition of the disorder, and a lack of ‘gold standard’ research measures for the classification of individuals as Internet addicted.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
- González-Bueso V, Santamaría JJ, Fernández D, Merino L, Montero E, Ribas, J. Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review. Int J Environ Res Public Health. 2018 Apr 3;15(4). pii: E668. doi: 10.3390/ijerph15040668. https://www.ncbi.nlm.nih.gov/pubmed/29614059
- Kuss DJ, Griffiths MD, Pontes HM. Chaos and confusion in DSM-5 diagnosis of internet gaming disorder: Issues, concerns, and recommendations for clarity in the field. Journal of Behavioral Addictions. 2017;6(2):103–109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520132/
- Liu L, Yao Y,Chiang-shan R, Zhang J, Xia C, Lan J,1 Ma S, Zhou N, Fang X. The Comorbidity Between Internet Gaming Disorder and Depression: Interrelationship and Neural Mechanisms. Front Psychiatry. 2018; 9: 154. doi: 10.3389/fpsyt.2018.00154, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924965/
- Park SM, Lee JY, Choi AR, Kim BM, Chung SJ, Park M, Kim IY, Park J, Choi J, Hong SJ. Maladaptive neurovisceral interactions in patients with Internet gaming disorder: A study of heart rate variability and functional neural connectivity using the graph theory approach. Addict Biol. 2019 Jul 12:e12805. doi: 10.1111/adb.12805, https://www.ncbi.nlm.nih.gov/pubmed/31297935
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- World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision).
- Young K. S. Internet addiction: A handbook and guide for evaluation and treatment. New York, NY: Wiley; 2010. Clinical assessment of Internet-addicted clients. In K. Young & C. Nabuco de Abreu (Eds.) pp. 19–34. www.wiley.com/.../Internet+Addiction%3A+A+Handbook+and+Guide+to+Evaluation+and+Treatment-p-9780470551165
- Zheng H, Hu Y, Wang Z, Wang M, Du X, Dong G, Choi JS1.Meta-analyses of the functional neural alterations in subjects with Internet gaming disorder: Similarities and differences across different paradigms.Neuropsychopharmacol Biol Psychiatry. 2019 May 27;94:109656. doi: 10.1016/j.pnpbp.2019.109656. https://www.ncbi.nlm.nih.gov/pubmed/31145927