Internet Gaming Will Soon Be Classified as a Mental Disorder

“Internet gaming addiction” is an expression bandied about with considerable regularity these days.  But like other compulsively enjoyed activities sometimes deemed to be “addictive” – porn, sex, gambling, exercise, and even caffeine – it remains unclear whether the label has genuine scientific status.

Just because people engage in an activity obsessively, do they really suffer from a dangerous addiction?  On the other hand, if the obsession is so intense that it costs them their job and the love of family and friends, how much does a label matter anyway?

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Scientific concern over the extent and consequences of online gaming has reached the point where public health specialists are considering whether to list it formally as a severe psychological condition in the Diagnostic Statistical Manual of Mental Disorders (known as DSM for short).

In DSM-V released last year, internet gaming is identified as a “disorder to watch.”  That’s significant because psychiatrists and psychologists have been extremely reluctant to take the same step with other conditions, including “sex addiction,” despite the prevalence of that expression in popular culture.

DSM-5 states that Internet Gaming Disorder (IGD) is most common in male adolescents 12 to 20 years of age. According to other studies, IGD is also thought to be more prevalent in Asian countries than in North America and Europe.  South Korea, Singapore, and China have been singled out for priority concern.

DSM-5 points to three progressively worse levels of IGD — mild, moderate and severe.  An article published in Psychology Today establishes that 5 of the following 9 criteria must be met in the previous year for someone to be considered suffering from IGD:

  1. There’s a preoccupation or obsession with Internet games.
  2. The gamer suffers withdrawal symptoms when not playing Internet games.
  3. The gamer develops a tolerance and needs progressively more time playing Internet games to be “satisfied.”
  4. The person has tried to stop or curb playing Internet games but has failed.
  5. The gamer has had a loss of interest in other life activities, such as hobbies.
  6. A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life.
  7. The person lies to others about his or her Internet game usage.
  8. The person uses Internet games as a way to escape feelings of anxiety or guilt.
  9. The gamer has lost or put at risk an opportunity or relationship because of Internet games.

Internet gaming is not the same as Internet gambling, which is already in the DSM manual as a subset of “gambling disorder.”  It is also distinct from heavy Internet gaming use because of its self-harming consequences and its compulsive nature.

About 160 million Americans – including 90% of children and teens — play Internet games, according to consumer research.  Among adolescents, the prevalence of IGD is estimated to be roughly 4.6% but appears much higher among males compared to females (about 6.8% to 1.3%).

Future research studies – including large scale clinical trials – are needed to clarify many aspects of IGD that remain unexplained.  One is the etiology of the disorder.  How do people come to be so addicted?  A second is demographics.  Why are some groups and individuals more susceptible?  A third issue is the influence of specific Internet games.  Anecdotal evidence strongly suggests that some games are more addictive than others.

Finally, there are “co-morbidities,” including depression and extreme anxiety that appear to be associated strongly with IGD, both as a risk factor and as a consequence. Better understanding these correlates could help make prevention and treatment efforts far more effective.

Presently, there is no known recommended treatment for IGD.  Parents are encouraged to monitor their children’s Internet use more closely and to establish stricter time boundaries for gaming.  Pediatricians and teachers that detect problems arising from IGD, including poor school performance and depressive symptoms, are encouraged to intervene.

In South Korea, where prevalence estimates for IGD are off the charts, special mental health facilities have been established to address IGD.

For now, the problem, while festering, still exists somewhat under the radar in America.  Part of the problem is denial:  Adults enjoy gaming to excess, too.  And for some parents, allowing children to game has become a convenient form of baby-sitting.

Too often, it’s our little ones that suffer from our own benign neglect.

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