The American Psychiatric Association decided that enough evidence exists to propose the potential disorder of video game addiction as a "condition requiring further study" in the Diagnostic and Statistical Manual of Mental Disorders as Internet gaming disorder. Video game addiction is a broader concept than internet gaming addiction, but most video game addiction is associated with Internet gaming. APA suggests, like Khan, the effects (or symptoms) of video game addiction may be similar to those of other proposed psychological addictions. Video game addiction may be an impulse control disorder, similar to compulsive gambling APA explains why Internet gaming disorder has been proposed as a disorder:
This decision was based upon the large number of studies of this condition and the severity of its consequences. .... Because of the distinguishing features and increased risks of clinically significant problems associated with gaming in particular, the Workgroup recommended the inclusion of only internet gaming disorder in Section 3 of the DSM-5.
Excessive use of video games may have some or all of the symptoms of drug addiction or other proposed psychological addictions. Some players become more concerned with their interactions in the game than in their broader lives. Players may play many hours per day, neglect personal hygiene, gain or lose significant weight due to playing, disrupt sleep patterns to play resulting in sleep deprivation, play at work, avoid phone calls from friends, or lie about how much time they spend playing video games.
APA has developed 9 criteria for characterizing the proposed Internet gaming disorder:
- Pre-occupation. Do you spend a lot of time thinking about games even when you are not playing, or planning when you can play next?
- Withdrawal. Do you feel restless, irritable, moody, angry, anxious or sad when attempting to cut down or stop gaming, or when you are unable to play?
- Tolerance. Do you feel the need to play for increasing amounts of time, play more exciting games, or use more powerful equipment to get the same amount of excitement you used to get?
- Reduce/stop. Do you feel that you should play less, but are unable to cut back on the amount of time you spend playing games?
- Give up other activities. Do you lose interest in or reduce participation in other recreational activities (hobbies, meetings with friends) due to gaming?
- Continue despite problems. Do you continue to play games even though you are aware of negative consequences, such as not getting enough sleep, being late to school/work, spending too much money, having arguments with others, or neglecting important duties?
- Deceive/cover up. Do you lie to family, friends or others about how much you game, or try to keep your family or friends from knowing how much you game?
- Escape adverse moods. Do you game to escape from or forget about personal problems, or to relieve uncomfortable feelings such as guilt, anxiety, helplessness or depression?
- Risk/lose relationships/opportunities. Do you risk or lose significant relationships, or job, educational or career opportunities because of gaming?
One of the most commonly used instruments for the measurement of addiction, the PVP Questionnaire (Problem Video Game Playing Questionnaire), was presented as a quantitative measure, not as a diagnostic tool. According to Griffiths, "all addictions (whether chemical or behavioral) are essentially about constant rewards and reinforcement". Griffiths proposed that addiction has six components: salience, mood modification, tolerance, withdrawal, conflict, and relapse. But, APA's 9 criteria for diagnosing Internet gaming disorder were made by taking point of departure in 8 different diagnostic/measuring tools proposed in other studies. Thus, APA's criteria attempt to condense the scientific work on diagnosing Internet gaming disorder.
The World Health Organization (WHO) has also proposed possible categories for "gaming disorder" for the forthcoming International Compendium of Diseases. A group of 26 scholars wrote an open letter to the WHO, suggesting that the proposed diagnostic categories lacked scientific merit and were likely to do more harm than good.
One meta-analytic review of pathological gaming studies concluded that about 3.0% of gamers may experience some symptoms of pathological gaming. The report noted problems in the field with defining and measuring pathological gaming and concluded that pathological gaming behaviors were more likely the product of underlying mental health problems rather than the inverse.
In year 2010, article 24 of ACM Journal of Computers in Entertainment (volume 8, issue 4) by Andrews Samraj and CK Loo suggested a built-in component based remedy for reverting the children back from the adverse damages caused by the video games.
A report by the Council On Science And Public Health to the AMA cited a 2005 Entertainment Software Association survey of computer game players and noted that players of MMORPGs were more likely to play for more than two hours per day than other gamers. In its report, the Council used this two-hour-per-day limit to define "gaming overuse", citing the American Academy of Pediatrics guideline of no more than one to two hours per day of "screen time". However, the ESA document cited in the Council report does not contain the two-hour-per-day data.
In a 2005 Tom's Games interview, Maressa Orzack estimated that 40% of the players of World of Warcraft (an MMORPG) were addicted, but she did not indicate a source for the estimate. She may have derived the estimate from the informal survey managed by Nick Yee at The Daedalus Project, who notes that caution should be exercised when interpreting that data.
A 2006 lecture reported by the BBC indicated that 12% of polled online gamers reported at least some addictive behaviours. The lecturer, Professor Mark Griffiths of Nottingham Trent University, stated in another BBC interview that addicts are "few and far between."
In 2007, Michael Cai, director of broadband and gaming for Parks Associates (a media/technology research and analysis company), said that "Video game addiction is a particularly severe problem in Asian countries such as China and Korea." Results of a 2006 survey suggested that 2.4% of South Koreans aged 9 to 39 suffer from game addiction, with another 10.2% at risk of addiction.
A 2007 Harris Interactive online poll of 1,187 United States youths aged 8–18 gathered detailed data on youth opinions about video game play. About 81% of youths stated that they played video games at least once per month. Further, the average play time varied by age and gender, from eight hours per week (responses from teen girls) to 14 hours per week (responses by teen boys). "Tweens" (8–12-year-olds) fell in the middle, with boys averaging 13 hours per week of reported game play and girls averaging 10. Harris concluded that 8.5% "can be classified as pathological or clinically 'addicted' to playing video games", but did not explain how this conclusion was reached.
Since the American Psychiatric Association decision in 2007, studies have been conducted at Stanford University School of Medicine related to video game play. Researchers found evidence that video games do have addictive characteristics. An MRI study found that the part of the brain that generates rewarding feelings is more activated in men than women during video game play.
The 2009 OSDUHS Mental Health and Well-Being Report, by the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, showed almost 10% of 9,000 surveyed students from Grades 7 to 12 get at least 7 hours a day of "screen time". A little over 10% also reported having video gaming problems in the previous year. A recent article in Pediatrics found a mild association between watching television or playing a video game and attention issues in more than 1,300 children ages eight to 11 years old. Children who played video games or watched television for more than the normal two hours a day maximum, which is recommended by the American Academy of Pediatrics were 1.5 – 2 times more likely to show signs of attention issues, the researchers found. However, the study was further criticized in eLetters to the same journal for failing to use well-validated measures of attention problems or control for other important variables. A more recent study using the Child Behavior Checklist and controlling for family and mental health variables, found no link between video game use and attention problems. Also, a study in Pediatrics found problematic gaming behaviors to be far less common, about 4%, and concluded that such problems were the result of underlying mental health problems rather than anything unique to gaming.
Writing in the Review of General Psychology's special issue on video games, Barnett and Coulson expressed concern that much of the debate on the issue of addiction may be a knee jerk response stimulated by poor understanding of games and game players. Such issues may lead both society and scholars to exaggerate the prevalence and nature of problematic gaming, and overfocus on games specifically while ignoring underlying mental health issues.
Other scholars have cautioned that comparing the symptoms of problematic gaming with problematic gambling is flawed, and that such comparisons may introduce research artifacts and artificially inflate prevalence estimates. For instance Richard Wood has observed that behaviors which are problematic in regards to gambling may not be as problematic when put into the context of other behaviors that are rewarding such as gaming. Similarly Barnett and Coulson have cautioned that discussions of problematic gaming have moved forward prematurely without proper understanding of the symptoms, proper assessment and consequences.
Some scholars suggest that psycho-social dependence may revolve around the intermittent reinforcements in the game and the need to belong. Some scholars explain that the social dependence that may arise due to video games occurring online where players interact with others and the relationships "often become more important for gamers than real-life relationships".
Through interviews with gamers who were addicted to a MMORPG but have quit playing, multiple reasons causing gamers to leave their game has been disclosed. This also reflects a number of aspects of online game addiction.
Many describe video game addiction to be a global mental health problem and that gamers who gain characteristics of addiction show decreased functioning in school, social, family, occupational, and social domains of their lives. Once addicted to video games, these youth are more likely to become depressed, anxious, and have lower academic achievement. In a qualitative analysis of online gaming addicts done by Marta Beranuy, Xavier Carbonell and Mark D. Griffiths they dived deeper into the source of gaming addiction in which one interviewer described it as a way of stress relief. "I played just to forget almost everything, it is like a second life. I was stressed but I found a way out to forget all my problems" [P2]. Another person described gaming as a medicine "it was a medicine for me. I was a bit depressed and left my job because I thought I was ill" [P7].
Though the study on the topic of gaming addiction is growing, the research is still young, and is therefore conducive to critique. Common challenges involve the reliability of the methodology and validity of the results in some studies. Many rely on self-surveys from University students and also lack time frames making it difficult to study the impact, if any, of addiction on a long term scale. Other concerns also address the definition of addiction and how to measure it, questioning whether or not time is a proper unit to determine how addicted someone is to gaming. A 2014 study done by Brunborg, Mentzoni and Froyland found that video game addiction does have a correlation with negative outcomes, such as depression. However, as stated in the article, the link between time spent on gaming and the same outcomes were found to be weaker than the former, showing that time may not be the only factor in gaming addiction.
Other challenges include the lack of context of the participant's life and the negative portrayal of gaming addicts. Some state that gamers sometimes use video games to either escape from an uncomfortable environment or alleviate their already existing mental issues – both possibly important aspects on determining the psychological impact of gaming. Negative portrayal also deals with the lack of consistency in measuring addictive gaming. This leads to discussions that sometimes exaggerated the issue and create a misconception in some that they, themselves, may be addicted when they are not.
Though the critiques are present, studies on this topic are still relatively young and growing and there is much to still be explored in this realm.
Video game addiction may indirectly lead to premature death: see Sedentary lifestyle § Health effects. Video game addiction may also lead to other health problems.
A Norwegian study conducted by the University of Bergen has looked at links between gaming problems and common health problems. The study compared health factors like headaches, neck or back pain, digestive problems and sleep problems between people with normal or no affiliation to gaming and people with gaming problems.
The study shows that people with gaming addiction are more exposed to all the tested health factors than the other groups.
The table below shows some numbers from the study. It compares the share of people who replied that they never had problems with each particular health factor between the groups "people with gaming addiction" and "people without gaming addiction".
The press has reported concerns over online gaming since at least 1994, when Wired Magazine mentioned a college student who was playing a MUD for 12 hours a day instead of attending class.
Press reports have noted that some Finnish Defence Forces conscripts were not mature enough to meet the demands of military life and were required to interrupt or postpone military service for a year. One reported source of the lack of needed social skills is overuse of computer games or the Internet. Forbes termed this overuse "Web fixations" and stated that they were responsible for 13 such interruptions or deferrals over the five years from 2000–2005.
In a July 2007 article, Perth, Western Australia, parents stated that their 15-year-old son had abandoned all other activities to play RuneScape, a popular MMORPG. The boy's father compared the condition to heroin addiction.
In an April 2008 article, The Daily Telegraph reported that surveys of 391 players of Asheron's Call showed that 3% of the respondents suffered from agitation when they were unable to play, or missed sleep or meals to play. The article reports that University of Bolton lead researcher John Charlton stated, "Our research supports the idea that people who are heavily involved in game playing may be nearer to autistic spectrum disorders than people who have no interest in gaming."
On 6 March 2009, the CBC's national news magazine program the fifth estate aired an hour-long report on video game addiction and the Brandon Crisp story, titled "Top Gun", subtitled "When a video gaming obsession turns to addiction and tragedy".
In August 2010, Wired reported that a man in Hawaii, Craig Smallwood, sued the gaming company NCsoft for negligence and for not specifying that their game, Lineage II was so addictive. He alleged that he would not have begun playing if he was aware that he would become addicted. Smallwood claims to have played Lineage for 20,000 hours between 2004 and 2009.
In January 2012, a video entitled "IRL – In Real Life" was released on YouTube. The film attracted widespread coverage on television, radio and in newspapers around the world. The film was made by graduate student film maker, Anthony Rosner. In the film he documents his experience with gaming addiction and how he was able to overcome it.
In 2013, a man from China observed his son's addiction to video games, and having studied these conditions for 25 years, decided to take action. He hired online assassins to kill his son's virtual avatar every time he logged in. He hoped that being relentlessly killed would help his son lose interest in this destructive habit.
According to ABC News, parents have many concerns about their children playing video games, such as:Age appropriateness: There is really no guideline to when a child should be introduced into the game world. Children have their own game of rights passage. There comes a time when a parent will know that their child is developed enough emotionally and socially and is ready for video games.
Play time: The National Institute on the Media and Family suggests that a child should have no more than an hour to play video games daily.
Health and obesity: For some parents, this should not be a concern because there are now video games that involve a lot of physical movement (Wii, Kinect). Parents should also require at least two hours of outdoors activities for their children.
Other concerns are addiction, safety concerns and violence, aggression and misbehavior.
The first video game to attract political controversy was the 1978 arcade game Space Invaders. In 1981, a political bill called the "Control of Space Invaders (and other Electronic Games) Bill" was drafted by British Labour Party MP George Foulkes in an attempt to ban the game for its "addictive properties" and for causing "deviancy". The bill was debated and only narrowly defeated in parliament by 114 votes to 94 votes.
In August 2005, the government of the People's Republic of China, where more than 20 million people play online games, introduced an online gaming restriction limiting playing time to three hours, after which the player would be expelled from whichever game they were playing. In 2006, it relaxed the rule so only citizens under the age of 18 would face the limitations. Reports indicate underage gamers found ways to circumvent the measure. In July, 2007, the rule was relaxed yet again. Internet games operating in China must require that users identify themselves by resident identity numbers. After three hours, players under 18 are prompted to stop and "do suitable physical exercise." If they continue, their in-game points are "slashed in half". After five hours, all their points are automatically erased.
In 2008, one of the five FCC Commissioners, Deborah Taylor Tate, stated that online gaming addiction was "one of the top reasons for college drop-outs". However, she did not mention a source for the statement nor identify its position in relation to other top reasons.
In 2011, the South Korean government implemented a law, known as the Shutdown Law or the Cinderella Law, which prohibits children under the age of 16 from playing online video games between the hours of 12 am to 6 am. However, as of 2014, the law was amended and now children under the age of 16 can play after midnight if they have permission from their parents.
Some theorists focus on presumed built-in reward systems of the games to explain their potentially addictive nature. Many video games, particularly massively multiplayer online role-playing games and social network and mobile games, rely on a "compulsion loop" or "core loop", a cycle of activities that involve rewarding the player and driving them to continue through another cycle, retaining them in the game. The anticipation of such rewards can create a neurological reaction that releases dopamine into the body, so that once the reward is obtained, the person will remember it as a pleasurable feeling. This has been found similar to the same neurological reaction believed to be associated with gambling addiction. In reference to gamers such as one suicide in China, the head of one software association was quoted, "In the hypothetical world created by such games, they become confident and gain satisfaction, which they cannot get in the real world."
Griffiths has also proposed that another reason why online video games are potentially addictive is because they "can be played all day every day". The fact that there is no end to the game can feel rewarding for some, and hence players are further engaged in the game.
A high prenatal testosterone load may be a risk factor for the development of video game addiction in adulthood.
Ferguson, Coulson and Barnett in a meta-analytic review of the research, concluded that the evidence suggests that video game addiction arises out of other mental health problems, rather than causing them. Thus it is unclear whether video game addiction should be considered a unique diagnosis.
Researchers at the University of Rochester and Immersyve, Inc. (a Celebration, Florida, computer gaming Think-tank) investigated what motivates gamers to continue playing video games. According to lead investigator Richard Ryan, they believe that players play for more reasons than fun alone. Ryan, a motivational psychologist at Rochester, says that many video games satisfy basic psychological needs, and players often continue to play because of rewards, freedom, and a connection to other players.
Michael Brody, M.D., head of the TV and Media Committee of the American Academy of Child and Adolescent Psychiatry, stated in a 2007 press release that "... there is not enough research on whether or not video games are addictive." However, Dr. Brody also cautioned that for some children and adolescents, "... it displaces physical activity and time spent on studies, with friends, and even with family."
Dr. Karen Pierce, a psychiatrist at Chicago's Children's Memorial Hospital, sees no need for a specific gaming addiction diagnosis. Two or more children see her each week because of excessive computer and video game play, and she treats their problems as she would any addiction. She said one of her excessive-gaming patients "...hasn't been to bed, hasn't showered...He is really a mess."
Because few clinical trials and no meta-analyses have been completed, research is still in the preliminary stages for excessive gaming treatment. The most effective treatments seem to be, as with other addictions and dependencies, a combination of psychopharmacology, psychotherapy and twelve-step programs.
Some countries, such as South Korea, China, the Netherlands, Canada, and the United States, have responded to the perceived threat of video game addiction by opening treatment centers.
Online Gamers Anonymous, an American non-profit organization formed in 2002, is a twelve-step, self-help, support and recovery organization for gamers and their loved ones who are suffering from the adverse effects of excessive computer gaming. The organization provides a variety of message boards, daily on-line chat meetings, a Saturday and Wednesday Skype meeting, and other tools for healing and support.
Computer gaming addicts anonymous cgaa.info, formed in 2014, is a recovery fellowship offering twelve-step support and fully following the Twelve Traditions. They have daily chat meetings at stepchat.com for support and recovery from computer gaming addiction of all kinds: video, console, PC, online, tablet, phone, arcade, etc.
The Chinese government operates several clinics to treat those suffering from overuse of online games, chatting and web surfing. Treatment for the patients, most of whom have been forced to attend by parents or government officials, include various forms of pain including shock therapy. In August 2009, Deng Sanshan was reportedly beaten to death in a correctional facility for video game and Web addiction.
In June 2006, the Smith and Jones clinic in Amsterdam – which has now gone bankrupt – became the first treatment facility in Europe to offer a residential treatment program for compulsive gamers. Keith Bakker, founder and former head of the clinic, has stated that 90% of the young people who seek treatment for compulsive computer gaming are not addicted.
McLean Hospital in Belmont, Massachusetts has set up Computer Addiction Services. Elsewhere, gamers may seek services at generalized addiction support centers.
In July 2009, ReSTART, a residential treatment center for "pathological computer use", opened in Fall City, near Seattle, Washington.
At a Computer Addiction Services center in Richmond, British Columbia, excessive gaming accounts for 80% of one youth counselor's caseload.
Network for Internet Investigation and Research Australia provides list of therapists who help video game and internet addicts.
Video game addiction may indirectly lead to premature death (see Sedentary lifestyle § Health effects). It is not normally a direct cause of immediate death.
Still, there have been at least few deaths caused directly by exhaustion from playing games for excessive periods of time. There have also been deaths of gamers and/or others related to playing of video games.
In 2007, it was reported that Mr. Zhang died in Jinzhou after playing online games persistently during the week-long Lunar New Year holiday as a result of a heart attack, brought on by a lack of physical activity. During the same year, reports indicated that a 30-year-old man died in Guangzhou after playing video games continuously for three days.
In 2012, two men in Taiwan died while playing computer games. The police "speculated that long hours in a sedentary position created cardiovascular problems" for the second, an 18-year-old.
The suicide of a young Chinese boy in the Tianjin municipality has highlighted once more the growing dangers of game addiction, when those responsible do not understand or notice the risks of unhealthy play. Xiao Yi was thirteen when he threw himself from the top of a twenty-four story tower block in his home town, leaving notes that spoke of his addiction and his hope of being reunited with fellow cyber-players in heaven. The suicide notes were written through the eyes of a gaming character, so reports the China Daily, and stated that he hoped to meet three gaming friends in the after life. His parents, who had noticed with growing concern his affliction, weren't mentioned in the letters.
In March 2005, the BBC reported a murder in Shanghai, when Qiu Chengwei fatally stabbed fellow player Zhu Caoyuan, who had sold on eBay a dragon saber sword he had been lent in a Legend of Mir 3 game, and was given a suspended death sentence.
In 2015, two men in Taiwan died after playing computer games for days in an Internet cafe.
In 2005, Seungseob Lee (Hangul: 이승섭) visited an Internet cafe in the city of Taegu and played StarCraft almost continuously for fifty hours. He went into cardiac arrest and died at a local hospital. A friend reported: "...he was a game addict. We all knew about it. He couldn't stop himself." About six weeks before his death, his girlfriend, also an avid gamer, broke up with him, in addition to his being fired from his job.
In 2009, Kim Sa-rang, a 3-month-old Korean child, died from malnutrition after both her parents spent hours each day in an Internet cafe, rearing a virtual child in an online game, Prius Online. The death is covered in the 2014 documentary Love Child.
An Earthtimes.org article reported in 2007 that police arrested a 13-year-old boy accused of murdering and robbing an 81-year-old woman. A local policeman was quoted as saying that the boy "...confessed that he needed money to play online games and decided to kill and rob..." the victim. The article further related a police report that the murder by strangling netted the thief 100,000 Vietnamese đồng (US$6.20).
In November 2001, Shawn Woolley committed suicide; it has been inferred that his death was related to the popular computer game EverQuest. Shawn’s mother said the suicide was due to a rejection or betrayal in the game from a character Shawn called "iluvyou".
In February 2002, a Louisiana woman sued Nintendo because her son died after suffering seizures caused by playing Nintendo 64 for eight hours a day, six days a week. Nintendo denied any responsibility.
18-year-old Devin Moore was addicted and obsessed with Grand Theft Auto: Vice City. He suddenly snapped and went on a crime spree on 7 June 2003. He was caught trying to steal a car and was brought in to the police station where he then managed to steal one officer's gun, and shot him and two other officers dead before stealing a police car and escaping. He was eventually caught and sentenced to lethal injection. After he was recaptured he said, "Life is a video game. Everybody's got to die sometime."
Press reports in November 2005 state that Gregg J. Kleinmark, 24, pleaded "guilty to two counts of involuntary manslaughter". He "left fraternal twins Drew and Bryn Kleinmark unattended in a bathtub for 30 minutes, in order to go three rooms away and play on his Game Boy Advance" while "in the mean time, the two ten-months old kids drowned".
Ohio teenager Daniel Petric shot his parents, killing his mother, after they took away his copy of Halo 3 in October 2007. In a sentencing hearing after the teen was found guilty of aggravated murder, the judge said, "I firmly believe that Daniel Petric had no idea at the time he hatched this plot that if he killed his parents they would be dead forever." On 16 June 2009, Petric was sentenced to 23 years to life in prison.
In Jacksonville, Florida, Alexandra Tobias pleaded guilty to second-degree murder for shaking her baby to death. She told investigators that the baby boy's crying had interrupted her while she was playing the Facebook game FarmVille. She was sentenced to 50 years in December 2010.
A New Mexico woman named Rebecca Colleen Christie was convicted of second degree murder and child abandonment, and sentenced to 25 years in prison, for allowing her 3 and a half-year-old daughter to die of malnutrition and dehydration while occupied with chatting and playing World of Warcraft online.
In March 2014, a 17-year-old boy assaulted and killed his grandmother in Quezon city after she scolded him for playing Defense of the Ancients at a local Internet cafe.In the Star Trek: The Next Generation episode "The Game", William Riker brings a video game from the planet Risa. It stimulates specific parts of the brain, and almost all of the Enterprise crew become addicted to it.
In the second segment of the 1983 American horror anthology film Nightmares, Emilio Estevez plays J.J. Cooney, a video game-addicted teenager who is consumed by a challenging arcade game named The Bishop of Battle.