Gaming Disorder

What is Gaming Disorder?

Gaming disorder can be considered on a ‘continuum that extends from healthy to hazardous and harmful to pathological behavior.’ (King & Delfabbro, 2019).

How to Define Gaming Disorder

Without consistently using accurate terminology when referring to gaming disorder, clinicians and helping professionals will regularly miscommunicate with clients, leading to confusion and ineffective therapeutic alliances. Many terms have been assigned to gaming problems, but not all of them are appropriate or effective.

INTENTA uses gaming disorder, problematic gaming and at-risk gaming to describe the range of issues that may arise from excessive gaming. Other definitions, such as internet gaming disorder, online video gaming and internet addiction are markedly imprecise, and therefore not used in the Gaming Disorder Clinical Training program.

We categorize gaming into four types:

Recreational gaming: This is gaming for fun without any notable at-risk behaviors associated with or within the game. Individuals may game casually, e.g. infrequently or irregularly.

At-risk gaming: This term refers to gaming behavior that does not yet have a pattern of consequences. It indicates identifiable behaviors that, if continued over time, may result in problems and ultimately disordered gaming.

Problematic gaming: This type of gaming behavior is significant but does not meet diagnostic criteria.

Gaming disorder: This description refers to disordered gaming as met by the diagnostic criteria.

Other Definitions of Gaming Disorder

As a new diagnostic classification, gaming disorder continues to develop through ongoing research. Multiple organizations have provided their own definitions of problematic and disordered gaming, and this blog will review the most important of these. Please note: it not a comprehensive list of all definitions but represents the best understanding in the research and clinical communities to date.

World Health Organization Classification (ICD-11)

world health organizationThe most important recent classification is from the World Health Organization (WHO). Its eleventh iteration of the International Classification of Diseases (ICD-11), will come into effect at the beginning of 2022.

The WHO has defined gaming disorder as follows: ‘Gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior (digital gaming or video-gaming), which may be online (i.e. over the internet) or offline, manifested by:

  1. impaired control over gaming (e.g. onset, frequency, intensity, duration, termination, context)
  2. increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and
  3. continuation or escalation of gaming despite the occurrence of negative consequences. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

The pattern of gaming behavior may be continuous or episodic and recurrent. The gaming behavior and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.’

In the ICD-11, gaming disorder is classified next to gambling disorder as ‘addictive behaviors.’ At INTENTA, we sometimes refer to gaming disorder as a gaming addiction but generally refrain from this terminology as it has multiple other implications and emotional attachments.

American Psychiatric Association Classification (DSM-5)

american psychiatric associationThe fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) released by the American Psychiatric Association includes a proposed criteria for internet gaming disorder. It is not an official disorder in the DSM. It suggests that more research is needed in order to classify gaming as an independent disorder.

According to the American Psychiatric Association, the proposed criteria for internet gaming disorder is the persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12-month period:

  1. Preoccupation with internet games. The individual thinks about previous gaming activity or anticipates playing the next game; internet gaming becomes the dominant activity in daily life. (This disorder is distinct from internet gambling, which is included under gam­bling disorder.)
  2. Withdrawal symptoms when internet gaming is taken away. These symptoms are typ­ically described as irritability, anxiety or sadness, but there are no physical signs of pharmacological withdrawal.
  3. Tolerance—the need to spend increasing amounts of time engaged in internet games.
  4. Unsuccessful attempts to control the participation in internet games.
  5. Loss of interest in previous hobbies and entertainment as a result of, and with the ex­ception of, internet games.
  6. Continued excessive use of internet games, despite knowledge of psychosocial problems.
  7. Has deceived family members, therapists or others regarding the amount of internet gaming.
  8. Use of internet games to escape or relieve a negative mood e.g. feelings of helplessness, guilt, anxiety.
  9. Has jeopardized or lost a significant relationship, job, or educational or career oppor­tunity because of participation in internet games.

It is interesting to note the similarities between the American Psychiatric Association (DSM-5) and the World Health Organization (ICD-11) classifications.

Prevalence of Gaming Disorder

There are 3 billion gamers worldwide and the vast majority play recreationally. Estimates in individual studies vary widely as to the number of people who suffer from gaming disorder. In 2020, a systemic meta-analysis was conducted of over 50 studies, representing more than 225,000 participants in 17 countries. They found a global prevalence of gaming disorder at approximately 2-3 % (Stevens et al. 2020).

Particular attention should be paid to female gamers who may be under-represented. Selective sampling of male gamers for research based on the reasoning that males are more vulnerable, contributes to the perception that gaming disorder is more of a male disorder, despite the above statistics showing the gender breakdown being quite evenly split (King & Potenza, 2020). This bias is underscored in treatment studies on gaming disorder, where there is a similar male bias, and therefore, knowledge of treatment efficacy is limited in females.

Read More: Gaming Disorder Prevalence

Gaming Disorder Symptoms

The physical signs of gaming disorder include poor sleep, lack of personal hygiene, physical health atrophy, exhaustion and dehydration (King & Delfabbro, 2019). Each of these can pose a serious risk to the gamer, including rare documented cases of death.

People playing hours of games per day also demonstrate some of the serious health effects of a sedentary lifestyle: poor diet, heart problems, muscle atrophy and blood clots. The mental health associations with gaming disorder include depression, anxiety, hostility, poor emotional regulation, interpersonal conflict and suicidal thoughts and/or attempts.

Gaming Disorder Research

Gaming disorder has become a significant issue in mental healthcare and yet it is still widely misunderstood. Despite the World Health Organization including gaming disorder in the International Classification of Diseases (ICD-11), there is still controversy by some members of the academic community who believe that the classification of gaming disorder lacks scientific basis.

According to the BMJ: ‘At present, the epidemiological survey data on gaming disorder among countries around the world are still in serious shortage. Therefore, future research directions include: (1) the epidemiological investigation of gaming disorder; (2) the development and standardisation of diagnostic tools; (3) the influencing factors of game behaviour; (4) brain imaging and neurobiology; and (5) treatment and prevention. In addiction, research on the positive role of gaming is also needed to clarify the nature of gaming disorder.’

While researchers, psychologists and policy makers discuss the issue, millions of people worldwide are struggling with gaming disorder. Individuals and their loved ones who are negatively impacted by gaming are seeking expert advice, and clinicians need to know how to help them.

INTENTA uses up-to-date research, clinical experience with gamers and lived experience of disordered gaming to help clinicians gain skills to become more effective when working with this vulnerable population.

Gaming Disorder Treatment

Gaming disorder treatment often uses techniques borrowed from substance abuse, depression and behavioral disorders. This is partly due to the co-morbidities of gaming problems with substance use, depression and ADHD. In the absence of official treatment protocols for gaming disorder, clinicians and counselors adapt existing techniques using their experience and expertise. However, the clinical evidence has yet to catch up on providing support for these various techniques in treating gaming addiction.

Read More: How to Treat Gaming Disorder

Gaming Disorder Training

Clinicians are increasingly encountering the changing demographic face of the problem gamer, as well as the associated negative consequences of those people for whom gaming has become a problem. INTENTA’s training equips clinicians with knowledge about the prevalence of problem gaming and its associated consequences, practical skills and clinical examples.

To find out more about INTENTA’s online training around problematic gaming, see our Gaming Disorder Clinical Training information. After completing the training, clinicians will be equipped with effective tools and skills, and know how to help someone with video game addiction.

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CLINICAL TRAINING

Gaming Disorder

A comprehensive understanding of problematic and disordered gaming with practical strategies for treatment and prevention.

References

  1. Adair, C. (2020). How many people are addicted to playing video games? Game Quitters. https://gamequitters.com/how-many-people-are-addicted-to-playing-video-games/
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
  3. BMJ. Research progress and debates on gaming disorder. https://gpsych.bmj.com/content/32/3/e100071
  4. Entertainment Software Association. (2019). Essential facts about the computer and video game industry. https://www.theesa.com/wp-content/uploads/2019/05/ESA_Essential_facts_20
  5. INTENTA (2021) Gaming Disorder Clinical Training. https://intenta.digital/training/gaming-disorder-clinical-training/
  6. King, D. L., & Delfabbro, P. H. (2019). Internet gaming disorder: Theory, assessment, treatment, and prevention. In Internet Gaming Disorder: Theory, Assessment, Treatment, and Prevention. Elsevier Inc. https://doi.org/10.1016/C2016-0-04107-4
  7. King, D. L., & Potenza, M. N. (2020). Gaming disorder among female adolescents: A hidden problem? Journal of Adolescent Health, 66(6), 650–652. https://doi.org/10.1016/j.jadohealth.2020.03.011
  8. Stevens MW, Dorstyn D, Delfabbro PH, King DL. Global prevalence of gaming disorder: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2020 Oct 7:4867420962851. doi: 10.1177/0004867420962851
  9. World Health Organization. (2018b). WHO releases new International Classification of Diseases (ICD 11). World Health Organization. https://www.who.int/news-room/detail/18-06-2018-who-releases-new-international-classification-of-diseases-(icd-11)

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