credit: Pexel

In August of 2016 in his New York Post article, Nicholas Kardaras told an anecdotal story about a six-year old boy and an iPad that read like a Stephen King novel. His mother bought the boy an iPad when he was in first grade, thinking she was helping him “get a jump on things.” He discovered the game Minecraft, which the technology teacher likened to electronic Lego. “Some mornings he would wake up and tell her that he could see the cube shapes in his dreams.” When his behavior worsened and she tried to take the game away from him, he threw temper tantrums. “Then, one night, she realized that something was seriously wrong.”

She went into his room to check on him—he was supposed to be sleeping—and found him sitting up in his bed, seemingly in a trance. “His bloodshot eyes looking into the distance as his glowing iPad lay next to him.” In a panic, she had to shake him several times to snap him out of it. “Distraught, she could not understand how her once-healthy and happy little boy had become so addicted to the game that he wound up in a catatonic stupor.” Kardaras said:

We now know that those iPads, smartphones and Xboxes are a form of digital drug. Recent brain imaging research is showing that they affect the brain’s frontal cortex — which controls executive functioning, including impulse control — in exactly the same way that cocaine does. Technology is so hyper-arousing that it raises dopamine levels — the feel-good neurotransmitter most involved in the addiction dynamic — as much as sex.

Peter Gray was more balanced in his article for Psychology Today, “Sense and Nonsense About Video Game Addiction.” Gray said that Kardaras claiming that “your kid’s brain on Minecraft looks like a brain on drugs” was utter nonsense. He cited gaming researchers who said video gaming doubles dopamine levels in the brain—about the same as eating a slice of pepperoni pizza. “Drugs like heroin, cocaine, or amphetamine raise dopamine by roughly ten times that much.” He went on to say video gaming can positively alter your brain, but did acknowledge research shows that a small percentage of gamers “are suffering psychologically in ways that at least are not helped by gaming and maybe are worsened.”

When the DSM-5, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders was published in 2013 it did not christen gaming as a distinct behavioral addiction. It did, however, include “Internet Gaming Disorder” in a section called “Conditions for Further Study.” In contrast, the World Health Organization (WHO) included “Gaming Disorder” as a distinct behavioral disorder.

The proposed diagnosis of Internet Gaming Disorder would mean “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.”  Then the following diagnostic criteria were given: 1) preoccupation with internet games; 2) withdrawal symptoms when gaming is taken away; 3) tolerance—the need to spend increasing amounts of time engaged in gaming; 4) unsuccessful attempts to control participation in gaming; 5) loss of interest in previous hobbies and entertainment activities other than gaming; 6) continued excessive use of gaming despite knowledge of psychosocial problems; 7) deception of family members, therapists or others about the amount of gaming; 8) use of gaming to escape or relieve a negative mood (like feelings of helplessness, guilt or anxiety); 9) gaming that jeopardized or led to the loss of a significant relationship, job, or either an educational or career opportunity.

Gray pointed out that preoccupation, tolerance, loss of interest in previous activities, deception, using to escape or relieve a negative mood could apply to anyone intensely interested in a hobby. “What I’m suggesting here is that a person who has a quite healthy passion for video gaming, who is not at all suffering, could very well check off these five “symptoms” and thereby get a diagnosis of IGD.” The other four seemed to him to be more indicative that something was wrong: withdrawal symptoms, unsuccessful attempts at control; continued excessive gaming despite psychosocial problems; risks of losing significant relationships or employment because of gaming.  He then briefly reviewed several studies of gaming addiction with a wide range of findings. Look at “Sense and Nonsense About Video Game Addiction” for his discussion of and citation of these studies. Here I’ll give an overview of a couple additional studies.

Torres-Rodriguez et al. wrote of their case study of four different types of adolescent problematic gamers in the International Journal of Mental Health and Addiction. The primary objective was to evaluate the effects of PIPATIC, a 22-session specialized treatment for adolescents with Internet Gaming Disorder (IGD). Given that all four cases had different etiologies leading to their problematic gaming, is was interesting that “the PIPATIC treatment was able to significantly reduce the negative symptoms and effects of IGD irrespective of the patients’ pathway and predispositions.” Three of the adolescents had comorbid disorders: autistic spectrum disorder, ADHD with depression and social phobia with depression.

In the American Journal of Men’s Health, Chen et al. examined how Internet Gaming Disorder was an emerging health issue for men. The authors observed where adolescent and adult males “demonstrate far more addictive internet gaming use in terms of screen hours, craving, and negative impacts on health, which have, in isolated incidents, also caused death.” They sought to do a literature review on IGD to raise awareness about IGD as an emergent men’s health issue. An intriguing section looked at studies seeking to conceptualize IGD through neuroscience. Conceived as a behavioral addiction, “a strong neurobiological link to addictive patterns has also been demonstrated in IGD.”

Although IGD is not recognized as an official mental health disorder, it is a significant emergent men’s health issue. If left untreated, IGD can lead to detrimental psychosocial impacts, affecting gamers and their families. PCPs can play an important role in providing early intervention, by knowing how to assess and treat men’s IGD; however, more research is needed to fully understand, accurately diagnose, and effectively treat this mental health condition.

The World Health Organization went further than the APA and classified Gaming Disorder in their eleventh edition of the International Classification of Diseases (ICD-11). When comparing the two descriptions, there are strong similarities, with the WHO definition being a more elegant and readable definition.

The ICD-11 said gaming disorder was defined as a pattern of gaming behavior “characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” For diagnosis, the behavior pattern must be severe enough to result in “significant impairment in personal, family, social, educational occupational or other important areas of functioning and would normally have been evident for at least 12 months.”

Writing for Medical News Today, in “What is gaming disorder?” Jayne Leonard reviewed the new ICD-11 disorder and explored what the classification could mean for gamers. She also noted the similarities between IGD and Gaming Disorder. There are also multiple links to additional studies, noting for example, how gaming may co-occur with anxiety, depression or stress. “People who remain physically inactive for extended periods due to gaming may also have a higher risk of obesity, sleep problems, and other health issues.”

Looking at what this could mean for gamers, Leonard said there was no doubt that some gaming behaviors were problematic. “But the majority of people who play computer and video games do not need to worry.” According to research into IGD assessed in a 2017 study by Przybylski et al., only .3-1.0 percent of people are likely to meet the criteria for an IGD diagnosis. More than 2/3 of individuals did not report any symptoms of IGD. Another study found individuals who did meet the criteria for IGD tended to have poorer emotional, physical, mental and social health.

Even though gaming disorder is not widespread, people should be aware of the amount of time that they spend playing games. They should also monitor the effect that gaming has on their other activities, their physical and mental health, and their relationships with others.

It doesn’t appear that like opioids, a gaming disorder epidemic will emerge. But it is wise to monitor gaming for impairment in some area of your life or the life of your children. And if a problem does emerge, there are gaming self help groups, like: “On-Line Gamers Anonymous. Look for the four diagnostic behaviors Peter Gray pointed out.

Do you feel restless when unable to play games (withdrawal)? Do you feel you should play less, but are unable to (unsuccessful attempts at control)? Do you continue gaming despite knowing it has a negative effect on your life (continued excessive gaming despite psychosocial problems)? And have you risked losing significant relationships or employment because of gaming?