Is Video Game Addiction a Disorder?

How gaming influences aggressive behavior has been hotly debated for decades. In this Psychiatric Times article, Rashmi Parmar, MD, and Julian Lagoy, MD, discuss how video games can lead to a dangerous obsession.

In Ohio, a 17-year-old boy shot both of his parents, killing his mother, because they took away his Halo 3 video game. His defense was that he was pushed to the brink by his addiction to video games, often playing for 18 hours straight.

In response to statistics like these, the World Health Organization (WHO) in 2018 officially included internet gaming disorder (ICD) in International Classification of Diseases, 11th Edition, noting that the disorder resulted in “marked distress or significant impairment in personal, family, social, educational, or occupational functioning.” WHO further noted other associated health concerns, including insufficient physical activity, poor diet, problems with eyesight and hearing, musculoskeletal problems, sleep deprivation, aggressive behavior, and depression, as well as poor psychosocial functioning.

Growing popularity or problem?

Brigham Young University recently released results of a 6-year study, the longest of its kind, on the effects of video game play and the trajectories of addiction. The results show that 10% of video game players exhibited pathological behavior. Pathological behavior includes playing video games excessively, which increases risk of depression, aggression, shyness, and anxiety, and is associated with the worst outcomes over time. The researchers concluded that it is not a “one-size-fits-all disorder.” Players who displayed pathological behavior tended to be males with low levels of prosocial behavior. They exhibited the worst long-term outcomes, with higher risks of depression, aggression, shyness, problematic cell phone usage, and anxiety when compared with the nonpathological control group.

Compared with nonplayers, gamers were found to have improved attention and visuospatial skills, likely due to increased blood flow and volumetric changes observed in the dorsolateral prefrontal cortex. Gamers had increased activation of several areas in the cortical ventral basal ganglia circuit, a prime network that influences reward-seeking behavior. The hippocampus, parahippocampus, and amygdala, which link emotions and memory to game-related cues, were also involved.

Studies have found that video game addicts tend to have poorer mental health and cognitive functioning, including poorer impulse control and more ADHD symptoms when compared with control groups. They also display increased emotional difficulties, such as depression and anxiety, feel more socially isolated, and are more likely to report symptoms indicative of problematic use with internet pornography.

Aggressive behavior

Although opinions and research conclusions remain divided, a clear constant remains: Males are generally more likely than females to develop video game addictions. Gender differences may also play a role, particularly as it relates to anxiety during late adolescence. Although it is hard to generalize results due to the limited sample, results of a study suggested that boys who played video games experienced the least anxiety, while girls had the most, conditions that were exacerbated when playing with others. Possible reasons could be that boys are more likely than girls to make friends online, feel more connected to friends during play, and use video games to engage with friends.

Studies have also shown that the length of play time and the type of video game have an impact on the game’s negative or positive effect. Games that featured more online social interaction resulted in fewer problematic gaming symptoms. Males playing nonsocial games appeared to have more social anxiety. Females who played social games had less social anxiety and loneliness but exhibited lower self-esteem than their male counterparts.

Treating video game addiction

In some cases, classifying video game addiction as a disorder could be useful, even if only a small percentage of people experience it. Such a distinction would allow clinicians to detect and treat other coexisting conditions, such as depression, anxiety, and substance addiction.

Several treatment options are available to address video game addiction, including cognitive behavioral therapy, family therapy, motivational interviewing, and solution-focused therapy, as well as combinations of these. Additionally, Online Gamers Anonymous, a 12-step recovery program established in 2002, offers an approach to break addiction similar to that of Alcoholics Anonymous and Narcotics Anonymous.

Read the full Psychiatric Times article with sources.