Since the early 2000s, and more so since the start of the pandemic, video gaming and the searchable term ‘gaming addiction’ has been steadily increasing. Prior to the 2000s, video games were typically found on arcade machines and were not accessible 24 hours a day. Now, video games can be found across different settings (e.g., social network sites, arcades, home) and platforms (e.g., cell phones, computers, tablets, and televisions) at any time of the day. The accessibility of technology and normalization of using electronics for work and school have been major factors contributing to the increase in gaming addiction amongst the population. Specifically for children, the accessibility to these devices for school has made it easy for them to get distracted and play video games instead of focusing on their schoolwork. Some of the reasons for why people engage in video games are: acquiring status and power in a game, competing and dominating others, receiving admiration from the gaming community, and escaping from reality.6, 12
What is the Definition of a Gaming Addiction?
While the term ‘gaming addiction’ is used amongst the mainstream population, the term ‘Internet Gaming Disorder’ is used in the DSM-5. An Internet Gaming Disorder defines a person who has a persistent and recurrent involvement of internet/video games leading to significant impairments in daily, work, and/or educational activities.1 A person with an Internet Gaming Disorder may appear to have:
- Preoccupation with gaming
- Withdrawal symptoms when videogaming is taken away
- Tolerance and the need to spend increasing amounts of time video gaming
- Loss of control and unsuccessful attempts to control participation in video games
- Loss of interest in previous hobbies and entertainment as a result of, and with the exception of, video games
- Continued excessive use of games despite knowledge of psychosocial problems
- Deceived family members, therapists, or others regarding amount of time spent playing games
- Use of games to escape or relieve a negative mood
- Negative consequences (jeopardized or lost a significant relationship, job or educational/career opportunity) because of participation in gaming. 1, 9
Risk Factors for Gaming Addictions
Children and adolescents are at greater risk of developing an Internet Gaming Disorder. Of this population, it is most prevalent in male adolescents between 12 to 20 years of age.1 Internet Gaming Disorder has been associated with high levels of aggression, hostility, neuroticism, loneliness, avoidant interpersonal tendencies, social inhibition, sensation seeking, and lower self-esteem5. Research shows that adolescents who display symptoms of depression, aggression, shyness, problematic cell phone use, and anxiety show a significant increase in their symptoms after excessive use of video games over time2. Moreover, it appears that high risk gamers have significantly low levels of self-control8. Below are the risk factors to developing a gaming addiction:
- Psychiatric comorbidity (depression, anxiety, ADHD, ASD, etc.)
- Emotional instability
- Lack of self-control
- Low self-esteem
- High sensation search
- Deficit of social skills
- Lack of supervision
- Conflictive family environment
- School environment with low performance, demotivation
- Major crises
- Drastic life changes10
What are the Physical Symptoms of a Gaming Addiction?
Physical symptoms of gaming addiction include:
- Difficulty paying attention and controlling impulses
- Poor emotion management (irritability, anxiety, depression, hostility)
- Carpal Tunnel Syndrome- overuse of a computer mouse or gaming controller can cause irritation and swelling in the hand and forearm due to squeezing and pressing on the main nerve.
- Dry eyes- caused due to staring at a screen for extended periods.
- Migraines- playing video games for extended periods can cause migraines due to the intense concentration required, strain put on the eyes, and loud noises/bright lights.
- Sleep disturbances- overstimulation of the brain can occur due to obsessive thinking and playing video games. Some individuals will play during the night or think about it instead of sleeping.
- Backaches- due to staying seated in the same position for hours and lack of movement, this can cause stiffness, soreness, and chronic back problems.
- Eating irregularities- not taking time to eat properly and eating food that is quick and unhealthy or not eating at all.
- Poor personal hygiene- necessities are not a priority such as showering, face-washing, and brushing teeth.4
How to Talk to My Child About Their Gaming Addiction?
It can be very shocking and worrisome for parents to recognize their child may have a gaming addiction. Parents may feel compelled to quickly remove all gaming devices and restrict their child from gaming in order to stop the behavior from continuing. However, setting rules and placing restrictive limitations can be counterproductive and cause an increase in stress for the child.
Having the conversation with a child can be difficult, especially since children are not thrilled at the idea of reducing their video gaming use. I have outlined 4 steps below to help parents communicate with their child regarding the problem and find ways to address the video gaming addiction: Understand, Explore, Discuss Implications, and Compromise.
- Understand- The first, and most important, step to speaking with your child will be to take an active role in helping them understand why they enjoy video gaming (e.g., escape, relaxation, feeling confident, winning, socialization, connection to others, etc). Your child will be nervous and react defensively during the conversation because they will be nervous that they not be able to play video games anymore. It will be important to tell your child that you want to talk and understand why they enjoy video gaming. Stay away from making decisions about their use and passing any judgement. When you are communicating with them, you want to show that you are on their team.
“I noticed that you have been playing video games for longer periods of time than usual. I can tell you are really enjoying it. I wonder what you enjoy most about the video games.”
- Explore- Once your child has shared what they are gaining from video gaming, it will be important to explore other activities in which they receive the same feeling.
“It sounds like you love playing video games because you enjoy winning and also feel a connection with the friends who you are playing with. I wonder if there are other activities that also make you feel good when you win and help you connect with people.”
- Discuss Implications- mention to your child that you are concerned with the amount of time they are spending playing video games versus the act of playing video games due to the symptoms you are seeing them display.
“I noticed that you haven’t been doing as well in school and you have been exhausted throughout the days. Your teacher mentioned that you have been sleeping in your class. I am concerned that this is because of the amount of time you have been playing video games.”
- Compromise- It will be very difficult for your child to stop playing video games completely. It would be beneficial to help them gain control of their gaming habit by slowly decreasing the amount of time spent playing. If your child is playing video games for 5 hours, it will not be effective to immediately limit their use to 1 hour a day. It is important that you slowly reduce the amount of time spent (e.g., from 5 hours to 4 hours and so on).
“If playing video games makes you feel happy and confident, then I want you to continue to enjoy it. However, we have to reduce the amount of time you spend playing video games so you can focus on your school work and get better quality sleep. Let’s try and only have you play for one hour after you are done with your homework and one hour after dinner.”
Some other general tips include:
- Give your child equally exciting alternative activities to choose from when they are not playing video games
- Encourage them to pursue a hobby
- Encourage them to spend time with friends or attend clubs/groups
- Build positive coping mechanisms (e.g., yoga, meditation)
- Encourage them to share their feelings
- Help them address the underlying problems (e.g., anxiety, depression, self-esteem)
Types of Gaming Addiction Treatment
Typically, video gamers are in therapy due to pressures and concerns from their parents or partner rather than by choice. Therefore, treatment should begin with Motivational Interviewing to motivate clients to change and recognize that their video gaming behavior is problematic.3 Once the client has an awareness to the extent and detriments of their video gaming habit, treatment techniques such as Behavior Therapy, Cognitive Behavior Therapy, Relaxation Training/Mindfulness, and Pharmacology will be effective.
- Behavior Therapy- utilize reinforcement strategies to encourage clients to set behavioral goals, reduce gaming behavior, and resist compulsions.3
- Cognitive Behavior Therapy- therapeutic model used to help the client identify and address unhealthy cognitions and social and behavioral deficits.11
- Pharmacology- medication management to decrease symptoms of underlying disorders such as anxiety, depression, or ADHD.13
- Relaxation Training/Mindfulness- to assist in coping with cravings, stress reduction, and accepting unwanted thoughts and distresses.7
Similar to the approach that Fifth Avenue Psychiatry takes with other addictions (e.g., alcohol, social media, gambling, cocaine), treatment for gaming addiction can also focus on complete sobriety or harm reduction. The challenge to sobriety of a gaming addiction comes from the difficulty of avoiding computers and electronics day to day. Another aspect to treatment may include teaching clients to use electronics responsibly and abstaining from giving into their impulses. However, other facilities may have a different perspective on treatment. Some facilities may believe that it is too risky to allow a client to play video games in a restrictive manner. Other options for treatment also include inpatient facilities in which clients are not allowed to use any gaming devices.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Coyne, S. M., Stockdale, L. A., Warburton, W., Gentile, D. A., Yang, C., & Merrill, B. M. (2020). Pathological video game symptoms from adolescence to emerging adulthood: A 6-year longitudinal study of trajectories, predictors, and outcomes. Developmental Psychology, 56(7), 1385–1396. https://doi.org/10.1037/dev0000939
- Dieris-Hirche, J., Bottel, L., Pape, M., Te Wildt, B. T., Wölfling, K., Henningsen, P., Timmesfeld, N., Neumann, A., Neusser, S., Beckers, R., Herpertz, S., & OMPRIS study group (2021). Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial. BMJ open, 11(8), e045840. https://doi.org/10.1136/bmjopen-2020-045840
- Griffiths (2008). Diagnosis and management of video game addiction. New Directions in Addiction Treatment and Prevention, 12, 27-41.
- Griffiths, M. D., Kuss, D. J., & King, D. L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8(4), 308–318. https://doi.org/10.2174/157340012803520414
- Kuss, D. J. (2013a). For the Horde! How Playing World of Warcraft Reflects our Participation in Popular Media Culture. Saarbrücken: LAP LAMBERT Academic Publishing. doi: 10.1097/01.nmd.0000158373.85150.57
- Li, W., Garland, E. L., McGovern, P., O’Brien, J. E., Tronnier, C., & Howard, M. O. (2017). Mindfulness-oriented recovery enhancement for internet gaming disorder in U.S. adults: A stage I randomized controlled trial. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 31(4), 393–402. https://doi.org/10.1037/adb0000269
- Macur, M., Pontes, H.M. (2021). Internet gaming disorder in adolescence: investigating profiles and associated risk factors. BMC Public Health, 21(1), 1547. https://doi.org/10.1186/s12889-021-11394-4
- Schivinski, B., Brzozowska-Woś, M., Buchanan, E. M., Griffiths, M. D., & Pontes, H. M. (2018). Psychometric assessment of the Internet Gaming Disorder diagnostic criteria: An Item Response Theory study. Addictive behaviors reports, 8, 176–184. https://doi.org/10.1016/j.abrep.2018.06.004
- Torres-Rodríguez, A., Griffiths, M. D., & Carbonell, X. (2018). The Treatment of Internet Gaming Disorder: a Brief Overview of the PIPATIC Program. International journal of mental health and addiction, 16(4), 1000–1015. https://doi.org/10.1007/s11469-017-9825-0
- Wölfling, K., Müller, K. W., Dreier, M., Ruckes, C., Deuster, O., Batra, A., Mann, K., Musalek, M., Schuster, A., Lemenager, T., Hanke, S., & Beutel, M. E. (2019). Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial. JAMA psychiatry, 76(10), 1018–1025. https://doi.org/10.1001/jamapsychiatry.2019.1676
- Yee N. (2006). Motivations for play in online games. Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society, 9(6), 772–775. https://doi.org/10.1089/cpb.2006.9.772
- Zajac, K., Ginley, M. K., Chang, R., & Petry, N. M. (2017). Treatments for Internet gaming disorder and Internet addiction: A systematic review. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 31(8), 979–994. https://doi.org/10.1037/adb0000315