Gaming and Mental Health: Therapy or Addiction (Part 2)

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Second of two Parts

Basics of Addiction

What is addiction, really, and why is the term being bandied about when it comes to video gaming?

A 2013 study by Eric J. Nestler, MD, PhD about the cellular basis of addiction stated that addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. Regardless of the involvement of a number of psychosocial factors, a biological process—one that is induced by repeated exposure to an addictive stimulus—is the core pathology that drives the development and maintenance of an addiction.

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This is aptly called “the brain disease” model of addiction, and may apply to many aspects of psychiatric diseases as well.

To put it simply, the study states that addiction at its core is a biological disease of the brain, alleviated or worsened by psychosocial factors. Although this model is currently being challenged in newer studies in the context of putting more emphasis on psychosocial factors having a core effect in the patient rather than it purely biological in order to individualize treatment but that topic is for another time. [READ: Gaming and Mental Health: Therapy or addiction? (Part 1)]

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The general consensus is that addiction is a biopsychosocial disorder characterized by compulsively seeking to achieve a desired effect, such as alcohol intoxication in alcoholic use disorder, despite knowing that it is harmful to self and others.

I have a disease, or do I?

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Is there really such a thing as a gaming addict?

Dr. Charibel Escandelor, a psychiatrist, discussed with DNX the possibility of a video gaming disorder as well as video games as therapy, perhaps as coping, especially in trying times like the current pandemic.

Escandelor admitted encountering a number of patients with psychiatric illnesses using video games, internet browsing, as well as streaming and television to cope.

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She educates them on healthy and unhealthy coping habits, because some patients may risk turning coping past-times into unhealthy habits that end up occupying a huge chunk of their lives and worsening their conditions.

This, however, is not limited to gaming and internet alone.

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She did assure that video games and internet browsing, just like various coping mechanisms have a spectrum of benefit and detriment.

She stated that individuals must be aware of the sweet spots that make these habits healthy, which is different from person to person. While psychiatrists have yet to accept Internet Gaming Disorder as a new diagnoses, they acknowledge that it warrants further study and may one day be diagnosed.

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Escandelor also acknowledged that in the context of gaming alone, a different demographic that makes the diagnoses harder to pinpoint – the existence of professional gamers who play video games for a living (some earning millions at that) and would normally clock hours of gaming that may span a regular work week to almost rivaling a doctor’s shift.
These pro-gamers have also been a topic of debate within the sports and athletic community if they may be considered to belong to the group, but that is a topic for another time.

The Diagnostic and Statistical Manual of Mental Disorders, which is considered as the diagnostic bible of Psychiatry, has yet to recognize video game addiction as a legitimate diagnosis for a psychiatric disease due to a lack of sufficient evidence. It does, however, state that video gaming addiction should be considered worthy of further study.

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Meanwhile the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO) listed it in its 10th edition (ICD 10) claiming that “Internet Gaming disorder” or IGD may be a fitting diagnosis, but many experts are divided in this matter.

The reason why this is a controversial topic from all sides of the demographic, namely the gamers, the video game companies, creators, doctors and scientists, the parents, the children and people in general is because diagnosing a patient as having “gaming disorder” or “video game addiction” could create a huge stigma on video games and gamers.

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It also means that it is technically a separate disease and warrants unique treatment.

However scientifically viable treatment options are actually inadequate due to limited research on the area. More often, based on studies, pathological gaming or excessive digital or internet use disorders and everything in between are actually manifestations of other more appropriate psychological disorders, rather than a separate entity.

IGD was found to be comorbid – or coexist – with numerous psychiatric diagnoses, including depression and anxiety.

A 2016 study by Andreassen, C. S. and co-authors titled The relationship between Addictive use of Social Media and Video Games and Symptoms of Psychiatric disorders published in the American Psychological Association found that addictive use of video games and social media was significantly associated with mental health disorder symptoms.

The study states that the culprit behind people who are “addicted to video games” are actually underlying known mental health diseases, and was identified as possible symptoms of attention deficit/hyperactivity disorder (ADHD) obsessive-compulsive disorder (OCD), anxiety and depression.

Regardless of these findings, note that there are few diagnoses of pathological gaming / Internet gaming disorder that exist in true isolation in the field of psychiatry, and even if these diagnoses is the result of a preexisting psychiatric disorder, it could develop into its own separate entity.

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For example, a person who begins drinking in order to cope with Major Depressive Disorder will often get both a diagnosis of alcohol use disorder and Major Depressive Disorder and will get treatment for both. So, if another person begins engaging in pathological gaming as a coping mechanism for managing the same depressive symptoms, it is worth questioning why giving the dual diagnoses of MDD and the addictive disorder would be appropriate in the alcoholism and depression, but not game addiction and depression.

Certainly, there are valid points in support of and against the creation of a gaming disorder diagnosis, but it is the identification of this disease entity’s impact on the patient population that should prompt attention from the field of psychiatry.

In a 2016 study by Andrew K Przybylski and co-authors on Internet Gaming Disorder published in the National Institute of Health, it stated that while the percentage of total gamers who meet proposed gaming disorder criteria appears quite small, the noted comorbidity between psychiatric diagnoses and pathologic gaming suggests that individuals who meet Internet Gaming Disorder criteria may more likely be psychiatric patients.

Furthermore, one benefit of identifying pathological gaming is opening new recognizable criteria for pathological behavior in the context of gaming and internet use that would help in identifying those who are actually experiencing a psychiatric disease. healthcare professionals, most especially psychiatrists, must be able to recognize this pathological behavior and help address it, just as they would help manage binge eating, drug and alcohol use etc. whether they may be maladaptive coping to an underlying disease or a stand-alone diagnoses entirely.

The Stigma of Game Addiction

While support of a gaming disorder diagnosis has its benefits, it has its risk of stigmatization. Those in healthcare too far off from the demographic of gaming might incorrectly assign pathologic behavior to healthy gamers due to the inclination of media outlets of using extreme examples like gamer deaths or even criminal acts relating to it.

For example, in 2008 a mother in Ohio lost her life when she found her 16-year-old son playing the video game, Halo, reportedly for up to 18 hours a day. She took the game away from her son, and the son, dismayed, took her life in turn by shooting her.

In 2010 in South Korea, an infant child died when the parent’s neglected its child’s care in order to play video games.

While these examples are rare and extreme, it should be noted that not every individual who plays games, plays until they experience a heart attack or an unstoppable urge. In the same way that not all alcoholic drinkers drink to the point of liver cirrhosis, or intoxication leading to accidents and deaths.

Yet we screen for alcohol use regularly, because at some point, there will always be a scenario where social use of alcohol may become an alcohol use disorder and the same can be said for gaming.

While a 2014 study by Peterson JK and co-authors on Law and Human behavior states that only 7.5% of criminal acts are attributable to mental illness, again it should be reiterated that a 2015 study by Swanson JW and co-authors published in the annals of Epidemiology state that the majority of people with serious mental illnesses are never violent, and are more often victims of violent crime. And that these examples of violence typically occurs in the context of complex social interactions, often in a family setting, health care settings and their community.

The American Psychological Association states that there is little to no evidence that violent behavior is related to video games.

Up next: Video Gaming as Part of our Lives

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