Video Game Addiction - Recent Findings to Blow Your Mind

By Cathy Cassata 04/29/14
Limits should be set on gaming habits to curb bullying, desensitization, and other potential problems.

It’s a typical day. Your son comes home from school, throws his book bag down and dashes to the Wii. You go back and forth. Should you tell him to stop? Let him play for a bit? Make him run around outside or require he does his homework first? Options abound, but uncertainty strikes. 

As concerns rise about the negative effects of video games, more and more parents find themselves wondering when the virtual world of jumping, dashing, building, and shooting becomes too much, and whether or not playing too often can lead to video game addiction. 

Mental health professionals differ in their opinion. In 2012, the Diagnostic and Statistical Manual of Mental Disorders (DSM) Task Force and Work Groups proposed that “internet use disorder,” which primarily refers to maladaptive video-gaming or internet gaming behavior, should be included in the DSM. As of now, it still isn’t included (DSM5 has categorized it as needing further study), but some mental health and medical professionals say this doesn’t mean it doesn’t exist. 

“I’m getting one to two referrals a week for children who are dealing with what I call pathological video game use,” said pediatrician and “mediatrician” Michael Rich, MD, founder of the Center on Media and Child Health at Boston Children’s Hospital, Harvard Medical School, and Harvard School of Public Health.

However, Rich says take caution when throwing around the word “addiction” in this sense. A national study published in Psychological Science in 2009 reported that 12% of boys and 8% of girls who play video games exhibit pathological patterns of play, and fit the DSM category of addiction. The study also showed that pathological gamers are twice as likely to have ADD or ADHD.

“Rarely do I see pathological video game playing in a child who doesn’t have an underlying issue, such as anxiety, depression, oppositional defiant disorder, ADD, or who falls within the autism spectrum,” said Rich. 

Why is this? Rich says there is a clear explanation. Children with ADD are attracted to video games because they provide a much more manageable environment and have built-in structure, giving the player a circumscribed environment with clear, consistent rules. “The real world has no clear, consistent rules or boundaries, so for someone with ADD, everyday life is very chaotic, confusing and distracting,” Rich explained.

For children who are on the spectrum, Rich says since they have difficulty reading clues from the environment, like facial expressions, video games simplify these signals and make outcomes predictable. “Video games have a much more controlled and limited vocabulary of symbols to learn, symbols that don’t rely on human expressions. Human faces and body language are the hardest thing for kids on the autistic spectrum to learn to read. In fact, skills-building video games can be positive for these children – there are wonderful apps and games that are specifically designed to help kids on the autism spectrum,” he said.

Who else is at risk?

Hilarie Cash, PhD, psychologist, author of Video Games & Your Kids: How Parents Stay in Control and co-founder of reSTART Internet Addiction Recovery Program in Fall City, Wash., agrees that people with mental health conditions are at higher risk for video game addiction. 

“Conditions like Asperger’s, or other painful conditions like depression, anxiety, and PTSD, are conditions which make life and being successful in life difficult. It’s easier to be successful in a video game, get recognition, have standing within a community much more than you can in the real world, so if you’re not having much success academically, or if you are, you’re not feeling socially successful, and you just don’t feel like you’re achieving what you want to achieve, you can instead turn to the world of video games and pretty quickly [receive] recognition, be admired and feel like you’re making a place for yourself in the world,” Cash said.

Cash also says simply being a teenager makes a person vulnerable. “The mere challenge of being a teen can be enough to drive kids to escape the challenges of adolescence. Some do this with pot and other substances, but now they have a handy escape right in their back pocket,” she said. “A poorly attached adolescent who doesn’t have a good family relationship is very vulnerable. Add a mental health illness on top of that, and they’re really set up for this addiction.”

Early exposure is another risk factor adds Cash. According to a Kaiser Foundation Report from 2010, elementary aged children use an average 7.5 hours per day of entertainment technology, including TV, video games, internet, movies, and cell phones. “Parents that are handing their kids devices early on are encouraging them to get drawn into, and even addicted to, these screens because their brains are developing very rapidly and wired for screens rather than wired for the rest of life,” she says. 

Are video games addictive by nature?

While some kids might be more prone to pathological gaming, you may wonder if video games themselves cause the problem. Cash says they certainly play a part. “If an addiction has to do with an elevation of chemicals in the pleasure region of the brain, think of video games as providing layers of pleasure. At the very simplest layer, there’s something called intermittent reinforcement, which is the unpredictability of reward, so you take an action and you don’t know if you’re going to be happy or unhappy with the outcome. You move one way and it’s the right move and you’re ahead. You move the other way and it’s the wrong move and you’re dead, well that’s intermittent reinforcement. It’s the basis of gambling addiction,” said Cash.

Rich adds that the goal of the video game developer is to hook people in using very established psychological techniques based on giving the gamer a challenge that can be mastered. “As they advance level after level, they get a nice squirt of dopamine each time, and are rewarded with another harder challenge. The creator thoughtfully figures out how to make it just hard enough to stymie someone just long enough so that they feel a great sense of satisfaction when they succeed at it, but not turn anybody off by being too hard. Addictive qualities are built in so the game player seeks that sense of accomplishment,” he said.

Cash says the most addictive games have deep layers of reward. “The fact that they can be played on and on for hours is a big part of the problem cause you’re overdoing it for hours on end and the brain is completely inundated with those chemicals that undergo the changes we call addiction,” she noted.

The idea that overplaying video games is solely due to the win factor doesn’t tell the whole picture says Geoffrey Ream, PhD, associate professor at the Adelphi University School of Social Work in Garden City, N.Y. “There’s a piece that can be explained medically and a piece that can’t. Dopamine is the obvious medical explanation because we produce it every time we feel like we’re ‘winning’ at something – gambling, shopping, sex, porn, etcetera. However, the idea that ‘behavioral addiction’ is all about dopamine kind of breaks down when it comes to video games. Some things people connect with in video games have nothing to do with winning or scoring points,” he said.

As part of a team who conducted research on the intersection of video game addiction and substance use for the National Institute on Drug Abuse, Ream discovered that the games that were more strongly associated with problem video play were games that involved identification with a fictional character. “Many people think massively multiplayer online role playing games, such as World of Warcraft, are the most addictive. However, when we looked at the full spectrum of genres, we found it was one of several genres with higher-than-average problem play potential. What all such genres seem to have in common is identification with a fictional character. There’s no medical explanation for this,” he said.

The study also found that while, according to earlier research, substance use usually peaks in young adulthood and diminishes later on in life, video gaming among study participants peaked in late high school and began to diminish in young adulthood. “With substance use, for most people, they get on with life. They get a job, they have a partner and have kids. They can’t keep smoking weed or whatever they were doing. Research calls this ‘role incompatibility.’ But there is a minority who doesn’t follow the normative curve downward. Their use levels keep getting higher, probably because they developed addictive patterns,” Ream said. “We can think of teenagers who play a lot of video games like we think of college students who drink a lot – yeah, we’re concerned, but most of them are going to calm down on their own. Who we’re worried about are the few who develop addictive patterns that will follow them through life and interfere with their development into adulthood and achievement of life goals.”

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Cathy Cassata is a freelance writer who writes about health, mental health and human behavior for a variety of publications and websites. She is a regular contributor to Everyday Health and Healthline. View her portfolio of stories at Connect with her on Twitter at @Cassatastyle.