Gaming Disorder – A New Frontier – Highlights from RCPsychIC 2019
This article is based on the talk by Dr Henrietta Bowden-Jones. Dr Henrietta Bowden-Jones is a medical doctor and neuroscience researcher working as a Consultant psychiatrist in Addictions.
Dr Henrietta Bowden-Jones was appointed Officer of the Most Excellent Order of the British Empire ( OBE) in the 2019 New Year’s Honours for Services to Addiction Treatment and Research.
Accurate prevalence rates of gaming disorder in the UK and across the world are unknown as there are many different screening tools in use, creating a challenge to compare ‘like with like.’ Of the data available, around 18-20% of males experience problems of internet addiction, and global prevalence rates are currently around 6% with the highest rates in the Middle East (10.9%) and lowest rates in Europe (2.6%).[Cheng C & Li A, 2014]
At the moment, there is high variability in prevalence surveys due to the inability of gaming instruments to map out diagnostic features of gaming disorder. [King D et al., 2013]
To address this, gaming disorder is now recognised by The World Health Organisation (WHO) in an updated diagnostic manual: the International Classification of Diseases 11th Revision (ICD-11),[WHO] and work is underway to find the best screening tools to provide an evidence base for treatment.
According to the ICD-11, gaming disorder is defined as:
- a pattern of gaming behaviour (“digital-gaming” or “video-gaming”) characterised 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.
- For gaming disorder to be diagnosed, the behaviour 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.
The International Society for the Study of Behavioural Addictions (ISSBA) is also dedicated to working with other non-government organisations which aim to recognise the symptoms of behavioural addictions in the population.[ISBA]
Excess of the internet can, of course, be functional rather than dysfunctional. Professional pressures today often lead to long hours online, e.g. preparing for talks, papers, and a disorder requires many negative consequences to be deemed problematic. The 2018 inclusion of gaming disorder in ICD-11 states that despite adverse consequences, there has to be escalation and continuation of the behaviour for at least 12 months. However, where there is evidence of someone failing school due to gaming compulsively, even over a shorter period, clinicians are more likely to begin working with them immediately.
Time zone differences play a significant part in the compulsive behaviour associated with gaming disorder due to the nature of games which involve groups of players. Preoccupation with the gaming world is another major factor in the criteria, and people suffer withdrawal symptoms when gaming is removed.
An extreme example was the case of Daniel Petric, who was convicted of murder. According to prosecutors at the murder trial, Petric shot his parents — killing his mother — because they wouldn’t allow him to play the violent video game Halo 3.
Some young people give up sporting activities, and after being very competitive in the real world, they now transfer that competitive nature to the online world. A transfer of friendships follows, which leads to social isolation, and then isolation from the family with increased hostility when parents intervene.
Recent neurobiological research has revealed shared characteristics of the brain in behaviour addiction patients with worse response inhibition and impaired prefrontal cortex functioning.[Kuss D et al., 2018]
A pilot treatment programme has led to the first NHS gaming clinic, which is currently under development, where CBT will be the treatment of choice.
Gaming disorder. World Health Organisation website. Published September 2018. https://www.who.int/features/qa/gaming-disorder/en/. Accessed 31 July 2019.
International Society for the Study of Behavioural Addictions (ISSBA). Available at: http://issba.elte.hu/. Accessed 31 July 2019.