Video game addiction

Did You Know?

• Individuals with low self-esteem may use MMORPGs to compensate by creating a powerful avatar, allowing them to overcome real-world anxieties.
• Spending on microtransactions, particularly loot boxes, has been linked to increased risk of both internet gaming disorder and gambling disorder.
• Cognitive-behavioral therapies have shown efficacy in reducing gaming disorder and depressive symptoms but not total time spent gaming.

Definition and diagnosis

The World Health Organization included gaming disorder in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), released in June 2018 and approved by the World Health Assembly in May 2019, with official use beginning on 1 January 2022. The American Psychiatric Association does not recognize video game addiction as a disorder but included internet gaming disorder as a condition requiring further study in the DSM-5. Video game addiction is a broader concept than internet gaming addiction, though most video game addiction is associated with internet gaming. The APA has proposed that internet gaming disorder may be an impulse control disorder similar to compulsive gambling, and has developed nine criteria for characterizing it: pre-occupation with games, withdrawal symptoms when unable to play, tolerance requiring increased play time, inability to reduce gaming, and giving up other activities. Additional symptoms include neglecting personal hygiene, weight changes, sleep disruption, playing at work, avoiding phone calls, and lying about time spent gaming. The APA's decision to propose internet gaming disorder was based on the large number of studies and the severity of consequences associated with gaming.

Research

A meta-analytic review of pathological gaming studies concluded that about 3% of gamers may experience some symptoms of pathological gaming, but noted problems with defining and measuring the condition, suggesting that pathological gaming behaviors were more likely the product of underlying mental health problems rather than the inverse. Some scholars have expressed concern that much of the debate on addiction may be a knee-jerk response stimulated by poor understanding of games and players, potentially exaggerating the prevalence and nature of problematic gaming while ignoring underlying mental health issues. Other researchers have cautioned that comparing symptoms of problematic gaming with problematic gambling is flawed and may introduce research artifacts that artificially inflate prevalence estimates. Rather than viewing video gaming disorder as a subtype of gambling disorder, a majority of researchers support considering it part of a broader framework of impulse control disorders involving pathological technology use, which shares behavioral and neural features with substance abuse and gambling disorder, though some have proposed that the concept of addiction should be de-medicalized.

History

The idea that video games could be addictive has been researched since the 1980s, and the number of studies on the topic has grown considerably since then. In the 1970s, Walter Bright recalled that some people at Caltech disliked his game Empire, even blaming it for students flunking out because they became addicted and stopped studying. One person even threatened him over it. By 1994, Wired had reported on a college student who played a MUD game for twelve hours a day instead of going to class. In Finland, some conscripts were deemed too immature for military service, and Forbes reported that overuse of computer games or the internet—which they called “Web fixations”—led to thirteen such deferrals between 2000 and 2005. A 2008 Daily Telegraph survey of 391 Asheron’s Call players found that three percent felt agitated when they could not play or missed sleep or meals to do so. In 2009, the CBC’s the fifth estate covered video game addiction in a report on Brandon Crisp. The following year, a Hawaiian man sued NCSoft, claiming he would not have played Lineage II if he had known it was so addictive. In 2013, a Chinese father hired online assassins to repeatedly kill his son’s virtual avatar, hoping to break his addiction.

Society and culture

Parents have many concerns about children playing video games, including age appropriateness, time spent, physical health, and aggressive behavior. The first video game to attract political controversy was the 1978 arcade game Space Invaders, leading to a 1981 British parliamentary bill called the Control of Space Invaders (and other Electronic Games) Bill, which was narrowly defeated. In August 2005, the Chinese government introduced an online gaming restriction limiting play to three hours, later relaxed to apply only to citizens under 18, though underage gamers found ways to circumvent it. In 2011, South Korea implemented the Shutdown law prohibiting children under 16 from playing online games between midnight and 6 a.m., later amended to allow play with parental permission, and moved to abolish the law in 2021. As of 2017, three main types of governmental policies existed: limiting availability, reducing risks and harm through warning messages, and providing addiction help services. Most policies were either not as efficient as intended or not yet evaluated, leading some researchers to call for a global public health approach and suggesting the video game industry should implement preventive measures.