Bradley Steffens. Addicted to Video Games. Reference Point Press, 2020.
Video game addiction is a behavioral addiction—a mental health condition in which a person repeatedly engages in a certain behavior, even if the behavior causes the person harm. Common behavioral addictions include compulsive gambling, shopping, hoarding, and impulsively stealing things (a condition known as kleptomania). A person with a behavioral addiction often is unable to resist engaging in it; it is a compulsion. Behavioral addictions have serious consequences for the addict. The behavior takes precedence over other life interests and daily activities. As a result it impairs personal, family, social, educational, occupational, and other important areas of functioning. These negative impacts define the addiction.
A Recognized Disorder
In June 2018 the World Health Organization included video game addiction in its International Classification of Diseases, 11th Revision (ICD-11). This manual is used by medical professionals around the world to diagnose diseases and mental health conditions. The mental health experts at WHO define video game addiction as “a pattern of gaming behavior (‘digital-gaming’ or ‘video-gaming’) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.”
Video game addiction differs from a healthy enjoyment of gaming when the activity has a negative impact on a person’s life and the gamer is unwilling or unable to stop it. To be classified as a disease, the negative impacts must be serious. WHO says,
For gaming disorder to be diagnosed, the behavior pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
Although video game addicts spend many hours engaged in the activity, it is not the amount of time spent playing that defines video game addiction. A 2014 study by a team of Norwegian researchers found no relation between the amount of time spent gaming and negative outcomes in everyday life. “Video game addiction was related to depression, lower academic achievement, and conduct problems, but time spent on video games was not related to any of the studied negative outcomes,” they write.
The inclusion of the disorder in the WHO manual is important for several reasons. First, it gives medical professionals around the world a single standard for identifying video game addiction. Second, it means that researchers can monitor video game addiction trends and statistics globally, because everyone is defining the disorder the same way, regardless of social, cultural, and medical backgrounds. These statistics will help identify the people who are most at risk of video game addiction. Third, the inclusion of video game addiction in the ICD-11 means more mental health professionals will be able to offer treatment tailored to video game addiction. And fourth, the inclusion of the disorder in the ICD-11 is something that governments will take into account when planning public health strategies and monitoring trends of disorders.
Douglas A. Gentile, a professor of psychology at Iowa State University, is one of those who is pleased by WHO’s action. “I think it will help in clinical practice because pediatricians, mental health practitioners and other health care professionals will be alert to symptoms,” says Gentile. “There are about 40 million children in the U.S. If 92 percent play video games and 8 percent of them would classify as having gaming disorder, that’s over 3 million children in the U.S. today causing serious damage to their lives because of the way they’re playing,” Gentile explains. “That’s a lot of kids who would benefit from getting help but up until now haven’t been able to because it hasn’t been considered a real diagnosis.”
“Over 3 million children in the U.S. today [are] causing serious damage to their lives because of the way they’re playing.” — Douglas A. Gentile, professor of psychology at Iowa State University
Cam Adair, a recovering video game addict and founder of the online support group Game Quitters, points out that WHO’s decision to designate video game addiction as a disorder is also good for healthy gamers. “For too long it’s been possible to suggest that someone has a video game addiction based on your own subjective reasoning,” says Adair. “No longer. We now have … official diagnostic criteria rooted in science and those concerned about someone’s gaming can trust a professional assessment.”
A Gamer’s Struggle with Addiction
An anonymous member of Game Quitters meets all of WHO’s criteria for video game addiction. His addiction lasted more than twelve months—several years, in fact—and his relationships and schoolwork suffered. And although he tried to give up video games several times, he always failed. It all began when he was about eight years old and his parents bought him a Nintendo video game console. “That thing got me so excited! I still remember shooting those ducks with a fake gun on the screen!” he says. His parents bought him more games. “I got better at them and then I moved to PlayStation 1. My favorite console ever,” he adds. His favorite games were Tekken and Lara Croft: Tomb Raider. He also subscribed to PlayStation: The Official Magazine to get all the hacks and cheats for his games.
The problem arose when his hobby began to affect his emotions. “I was so competitive!” he recalls. “I was getting so mad when I lost.” His parents, however, did not think his passion for gaming was unhealthy. “They thought it was funny,” he says. He remembers them saying, “Let the kid be a kid and we go do our adult stuff.” But gaming was beginning to replace real life as the most important thing in his life. “Gaming was my escape from the world,” he says. “Escape from bullying, from bad family communication, from bad parenting, failed relationships, and psychological issues.”
“Gaming was my escape from the world. Escape from bullying, from bad family communication, from bad parenting, failed relationships, and psychological issues.” — A recovering video game addict at Game Quitters
The teen’s hobby became an addiction when the Internet became faster and he began playing Lineage II, a massively multi-player online role-playing game (MMORPG) in which he was part of a worldwide team. “My character was my life,” he admits. “I remember I used to daydream about the game during school time. Draw pictures of weapons and enemies! Making phone calls with my guild clan members. I even had my own guild.” When he was seventeen, he played for twenty-four hours straight just to move up one level of the game. “My psychology started to change, I became more bored of real life, more avoidant of people, and sports started to get less interesting and more tiring. I became less fit and more fat. I had bad eating and sleeping habits, and poor posture.” He began to have problems with his schoolwork, and his parents pressured him to stop playing video games. “Those were really bad times, but that game was my life,” he remembers. “I was very respected and liked online. That was tremendous to me because in real life I was getting bullied and mistreated a lot, and thus had very low self-esteem.”
He went to college to study computer science, thinking he would become a game designer and give others the joy that gaming gave him. But his studies suffered because of his gaming. It took him seven years to complete a degree that most of his classmates completed in four years. The addicted gamer finally recognized that he had a problem. At twenty-five he began to cut back on MMORPGs, but he still played World of Warcraft, League of Legends, and Hearthstone. He finally broke his addiction at age twenty-nine. “I still have self-esteem issues that I am working on,” he says. “My family and I are working to fix our issues after all these years. I am inexperienced with relationships and still a virgin. I moved back in with my parents at 25 and still live with them at 30. I feel kind of stuck, but at the same time I am trying to move forward little by little.”
The Demographics of Video Game Addiction
The anonymous Game Quitters contributor fits the demographic profile of a video game addict. Demographics are statistical data relating to the population and particular groups within it. Public health officials use this data to identify the groups most at risk of a disease or mental condition. In the case of video gaming, the Pew Research Center has found that 43 percent of US adults play video games on a computer, TV, game console, or portable device like a cell phone, but those under fifty years old are twice as likely to play video games as those who are older. Fully 55 percent of people under the age of fifty play video games sometimes or often, while only 28 percent of those fifty and over do. As the age goes down, the number of people who play video games—and are at risk of becoming addicted to video games—goes up. Among US adults aged eighteen to thirty-four, 60 percent play video games. The activity is even more popular among teens. An incredible 90 percent of US teens say they play video games.
While large numbers of both men and women play video games, men play more than women do, according to the Pew Research Center. Among all ages, 47 percent of men play video games, compared with 39 percent of women. The gender difference is greater among younger adults: 72 percent of men ages eighteen to twenty-nine play video games compared with 49 percent of women in the same age range. The gender gap is smaller among teens. An astounding 97 percent of teenage boys play video games, but 83 percent of girls do, too. There is an important difference between the genders, however. Far more young men (33 percent) identify themselves as “gamers” than do young women (9 percent). Identifying oneself as a gamer reveals a deep connection to the video game world. This connection shows up in the number of people actually addicted to video games. According to Tech Addiction, a Canadian treatment center and information service for people who struggle with controlling their use of technology, 94 percent of gaming addicts are male. The average age of a gaming addict is twenty-four years old.
“I wasn’t even playing with other people; it was just me and the same few games, again and again. Some people may misinterpret if I say ‘like a drug.’ But in my experience, it was like a drug.” — José Antonio Hita Ruiz, recovering video game addict
José Antonio Hita Ruiz is another gamer who fits the risk profile. His father was an alcoholic, and his mother supported the family by working long hours. Ruiz comforted himself by playing video games. His grades suffered, and he was bullied, so he soon dropped out of school. He filled his time by playing video games. “I wasn’t even playing with other people; it was just me and the same few games, again and again,” Ruiz recalls. “Some people may misinterpret if I say ‘like a drug.’ But in my experience, it was like a drug.” His friends went off to college, leaving Ruiz behind. “There was a point where I was completely alone,” he says. Ruiz became depressed and began to have suicidal thoughts. To numb the pain, he played video games even more. Finally, he had an emotional breakdown and checked himself into a hospital. He knew he had to quit gaming or else he would end his life. He never played again.
The Prevalence of Video Game Addiction
Experts disagree about how many people are addicted to video games. WHO estimates that between 3 percent and 4 percent of all gamers meet its criteria for addiction. That would mean that between 4.5 million and 6 million Americans are video game addicts. Researchers led by Andrew Przybylski, a professor and experimental psychologist at the Oxford Internet Institute, a part of Oxford University in England, however, believe the number is much smaller.
In a 2018 study Przybylski’s team analyzed surveys of 18,932 gamers in the United States, Canada, the United Kingdom, and Germany who played online video games. To measure addictiveness, the team used the American Psychiatric Association’s definition of Internet gaming disorder (IGD), which is slightly different from the World Health Organization’s definition of gaming disorder. Przybylski’s team found that while a third of gamers reported having some of the symptoms of addiction, only 0.3 percent to 1 percent of gamers reported having all of them and thus qualifying as addicts. If correct, Przybylski’s estimate would mean that between 450,000 to 1.5 million Americans are addicted to Internet video games. “Video game addiction might be a real thing, but it is not the epidemic that some have made it out to be,” wrote the authors of an editorial that appeared along with the study in the Journal of American Psychiatry.
Not everyone agrees with Przybylski’s findings. A 2017 study led by Gentile used a definition developed by the IGD Working Group of the National Academy of Sciences to identify video game addiction—a definition that covers both online and offline gaming. “Despite its name, IGD does not require that individuals exhibit symptoms of addiction solely with online video games,” explains Gentile’s team. “Problematic use can occur in both offline and online settings.” Gentile’s team found that between 1 percent and 9 percent of gamers are addicted to video games. According to this finding, between 1.5 million and 13.5 million Americans are suffering from video game addiction. That means as much as 4 percent of the US population could be addicted to video games. “This is a serious thing,” says Adair. “We need to help people with it. It’s not enough to continue to ignore it.”
Mental health experts disagree on how widespread video game addiction is, but there is no doubt that it exists. And it is having devastating effects on millions of gamers.