When the World Health Organisation added gaming disorder to the latest edition of its International Classification of Diseases (ICD-11), widespread media coverage and an outcry from the gaming industry made it the issue of the moment. The classification applies to people with 12 months of low control over their gaming habits, escalating to the extent that they neglect other activities or basic functions, even when it puts them at risk.
But is gaming disorder a sign of genuine addiction, or is it pathologizing the behaviour of a small minorities of gamers in a multi-billion-pound industry?
Is ‘Gaming Disorder’ Real, or Are We Overreacting?
Gaming disorder might sound far-fetched on paper: being glued to a video game for hours on end is practically a rite of passage for many teenagers these days. Furthermore, many teens see the gaming industry as a career option, where jobs can range from designing and making games to entering tournaments and video blogging your own achievements on YouTube. The power and hype of the gaming industry means your child may have a valid excuse when they head to their console or computer for another session, particularly if they join multi-player online games with their friends, but there is a dark side to consider.
News reports of gamers dying during marathon gaming sessions are rare enough to be shocking, and they show the extreme side of video gaming that can affect a minority of users.
Games involve many different levels or stages, and the pressure to complete them intensifies when you join an online team or community: there’s a genuine fear of letting others down if you don’t complete a level, put the hours in or play to a high standard.
The WHO’s actions haven’t come out of the blue, either: in May 2013, the American Psychiatric Association added ‘internet gaming disorder’ to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the main point of reference for psychiatrists.
What is Addictive Behaviour?
It can be helpful to compare gaming disorder to other well-known addictive behaviours, such as gambling or drinking. There are many people who enjoy gambling as a hobby, perhaps playing poker, going to the casinos of Las Vegas or placing bets at the races; there are others whose gambling is out of control and has taken over their entire lives. Similarly, there are people who readily enjoy drinking and can manage their intake, but others find themselves dependent on alcohol and struggle to live without it.
Gaming triggers specific parts of your brain – the area we often refer to as the ‘reward centre’. Dopamine is released when the brain registers pleasure from any activity, whether from winning a prize, buying new shoes or having a lovely meal, so in gaming it may be because the player has completed a level, beaten an opponent or started the latest must-have game. Memories and stimulus responses are also created in the brain’s ‘reward centre’, so the player can relive that moment of triumph and respond to the same stimulus in the same way, knowing a reward of a temporary high may be due.
As a gaming compulsion or disorder develops, the player’s brain gets a more intense rush of dopamine, but they need more of the activity to feel good because they have developed a tolerance. They may begin taking risks and spending time and money beyond their means to keep feeding the addiction. When they can’t relieve the cravings, or the feeling of satisfaction wears off, they feel low and empty, often to the point of distraction.
Symptoms of any addictive behaviour, including gaming disorder, can include:
- Changes in performance and timekeeping at school or work
- Paying little attention to their physical appearance and hygiene
- Lack of interest in hobbies they previously enjoyed
- Weight loss and changes in appetite
- Mood swings and irritability
- Sudden secrecy and dishonesty, especially when confronted
Remember the addiction, in this case to gaming, needs to continue for at least 12 months to meet the WHO’s criteria. The difficulty is that teenagers and young adults experience huge biological and hormonal changes and can exhibit some of the symptoms above as part of normal ‘growing pains’; scientists have found teenagers’ body clocks shift, so it’s unsurprising they seem tired. Some young people also go through phases of seemingly neglecting their personal appearance, changing eating patterns and being secretive, especially as their bodies change so dramatically. This makes it harder for parents, teachers and GPs to spot the signs of addiction, which may just be labelled as typical teenage behaviour, so it’s important to sit down and talk to your child face to face.
If it does emerge that gaming has become an issue, or part of larger behavioural patterns, such as withdrawal or self-neglect, talking therapy can be helpful. Family therapy or individual CBT (Cognitive Behavioural Therapy), if your child or teenager is willing, can break down barriers and explore the root cause of these issues. A psychologist then develops strategies with the family or individual to help change their habits. Whilst being addicted to gaming is rare, it is treatable.
Talking to Your Child About Gaming
Aside from thinking about those symptoms, try to keep an eye on your child’s gaming habits: how many hours do they spend on their console or computer? Are they on multi-player games with friends only, or do they join in games with strangers from around the world? Where possible, limit children’s time alone in their room on a device; build up a routine they can stick to, with gaming as a post-homework treat rather than an automatic right. You could try getting involved as a family, too – gaming systems with multiple controls allow friends and family to play against each other in the same room.
Virtual friendships can quickly build up through gaming, and children can rely on these relationships despite having no face-to-face contact with their online friends. People who befriend young gamers don’t necessarily have sinister motives, but a young and impressionable gamer may struggle if they lack real life friendships.
Balance virtual experiences with related experiences in the real world: if your child enjoys football games, get them outside playing or watching matches; if they prefer war-themed games, visit a real-life battlefield, try archery or go paintballing; for sci-fi fans, a trip to an escape room or sci-fi related convention is perfect.
You should also be mindful of prejudice across the gaming industry: female-identifying workers and players are often subjected to offensive comments, either criticising them (particularly during the 2014 #Gamergate controversy) or making unwanted sexual advances. Even male gamers using female avatars, usernames or character identities have found themselves facing more harassment than when they present as male.
The gaming industry is still notoriously biased towards white heterosexual middle-class men, making other groups feel under-represented; it isn’t a racially diverse or gender diverse environment, and prominent YouTube gamers like PewDiePie have openly made racist comments whilst retaining their fan-base and earning millions. You can encourage tolerance at a young age with this list of positive female role models in gaming for ages 5+, 10+ and beyond, and look at organisations like BAME in Games for older teens.
Talk to your child’s school: is internet safety being covered in IT or PSHE lessons and, if so, do they talk about online friendships, virtual identities, sexism and the pitfalls of gaming? Schools shouldn’t ignore these issues when they directly affect a child’s behaviour and performance.
Gaming disorder is a valid concern for parents, teachers and psychologists, but fortunately it affects a minority of users. However, even if a child doesn’t show signs of addictive behaviour, there’s no reason not to establish healthy boundaries and rules around gaming – after all, this should be a hobby, not an all-consuming habit.
Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).