What is an addiction, exactly?

Sources such as Wikipedia define addiction as "a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences." This description, while useful enough when talking about drug or alcohol addiction, can become more difficult to apply to problem behaviors such as gambling or compulsive shopping.  

With gambling addiction, for example, we usually talk about a persistent need to gamble that can interfere with work, school, and healthy pastimes. Compulsive gambling can also lead to financial ruin, undermine mental health, and result in permanent shattering of family and social relationships. In that respect, we can call it an addiction even though there are no external signs of a disease and certainly no medical tests that can be use to diagnose this kind of problem behavior.

Certainly there is no disputing the fact that millions of young people around the world devote countless hours to playing video games.  Within the past two decades, video game culture has evolved along with Internet culture to create entire social networks that allow gamers to immerse themselves in ways that have never been possible before.  

In addition to movies, television, music, and YouTube videos about gamers, news stories about the negative aspects of video game playing has sparked a backlash among parents' groups.  At the same time, many researchers have weighed in with studies showing the impact of video gaming on problem behaviors in adolescents. Stereotypes have also sprung up depicting gamers as physically unfit "nerds" with few social skills, though actual evidence to back up these stereotypes is often lacking.  

Not surprisingly, treatment centers aimed at curing "video game addiction" have opened across the United States as well as parts of Europe and Asia and appear to be doing brisk business.  While most video gamers show few problems, some experts suggest that around 10 to 12 percent can be considered addicts who spend 10 hours a day or more on gaming.  But defining a video gaming disorder continues to be a challenge for mental health professionals.

Though the American Psychiatric Association has listed "Internet gaming disorder" (IGD for short) in the DSM-V, it is only as a possible diagnosis for inclusion in future versions. Even coming up with a proper name for the diagnosis is tricky though and terms such as "Internet use disorder, Internet addiction, or gaming addiction" have also been proposed.  Originally intended for Internet gaming alone, IGD has since been expanded to include all forms of online gaming that don't involve gambling (which would be covered under gambling addiction).  Proposed symptoms for IGD include:

  • Preoccupation with Internet games/gaming becomes predominant activity
  • Withdrawal symptoms (anxiety or sadness when game is taken away)
  • Tolerance (need to spend more time gaming)
  • Unsuccessful attempt to control amount of gaming
  • Loss of interest in previous hobbies
  • Continued use despite problems
  • Deceived family about time spent gaming
  • Gaming to escape negative mood
  • Relationship problems due to gaming

To meet the IGD diagnosis, gamers need to show five or more of these symptoms over a 12-month period.  The DSM-V work group that developed the IGD diagnosis reviewed more than 240 research articles showing similarities to gambling and substance abuse disorders.

But how valid is this proposed diagnosis? And how far should mental health professionals go in labeling certain behaviors as mental disorders?  A new article in the journal Professional Psychology: Research and Practice discusses the concept of video game addiction as well as the controversy surrounding how it should be defined. Written by Anthony M. Bean of Framingham University and an international team of academic psychologists, the article explores many of the problems surrounding IGD and the political battle to include it as part of the DSM.    

This political battle became readily apparent when the World Health Organization (WHO) first proposed including "gaming disorder" and "hazardous gaming" in the next version of the International Classification of Diseases (ICD-11).  As Bean and his co-authors point out, the current proposed symptoms for these new diagnostic categories are even more vague than in the DSM.  Also, the researchers who have been tasked with running field tests of the new diagnoses have openly admitted to dealing with considerable political pressure to get them approved despite the limitations.

Another problem, as Bean et al point out, is that the current IGD diagnosis is based purely on certain behaviors that are treated as symptoms of an underlying mental illness. In the same way that we can't declare excessive watching of television football or participating in fantasy football games as a mental illness (so far, at least), there is little real evidence that excessive internet gaming can be considered as a mental disorder as such.  

Part of the problem is that the current diagnosis has been adapted from the language used to describe other forms of addiction such as substance abuse or problem gambling. This is why terms such as "tolerance" and "withdrawal" have been included even through there is little real evidence that they actually apply to gamers.

Bean and his co-authors also argue that the current criteria proposed for diagnosing IGD are much too broad.  Since criteria such as "Preoccupation with Internet games/gaming becomes predominant activity, "Loss of interest in previous hobbies," and "gaming to escape negative mood" can apply to virtually any gamer regardless of amount of time spent playing, the risk of false positives when diagnosing IGD is unacceptably high.  As it stands, telling the difference between video game addiction and high engagement play may not be possible.

But in a real sense, there is nothing new about the current worry over video gaming and whether it represents a mental disorder or not. While there are certainly young people who may use video games as an escape from the problems in their lives, even to the point of neglecting all other social outlets, actual evidence that this constitutes a disorder entirely separate from existing diagnoses such as social anxiety or major depression is still lacking.  

Despite the political pressure to declare video game addiction a real disorder, the basic science still isn't there.  As a statement released by the American Psychiatric Association back in 2013 states: “The literature suffers, however, from lack of a standardized definition from which to deprive prevalence data. An understanding of the natural histories of cases, with or without treatment, is also missing.”    

Unfortunately, we are already seeing the consequences of overeager therapists attempting to treat young people for a disease that may not even exist.  In China, for example, military-style "boot camps" for the treatment of video game addicts have become extremely popular with parents sending their children to be "cured," often after weeks or months of grueling treatment.  Though this may be an extreme example, the potential for predatory programs of this type being established elsewhere can't be ignored.

While video games seem here to stay, the controversy over video game addiction is unlikely to go away anytime soon. Where this will take us in future is anybody's guess at this point.

References

Bean, A. M., Nielsen, R. K. L., van Rooij, A. J., & Ferguson, C. J. (2017). Video Game Addiction: The Push To Pathologize Video Games. Professional Psychology: Research and Practice. Advance online publication. http://dx.doi.org/10.1037/pro0000150

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