Pathological gaming addiction has been included in the most recent version of the DSM-5 in ‘Section 3’, dedicated to conditions requiring further study and investigation

Specifically, we find it under the label ‘Internet Gaming Disorder’, which includes addiction to both online and offline video games

It should be mentioned that Internet Gaming Disorder is the only other behavioural addiction included, along with pathological gambling, in Section 3 of the DSM-5 (American Psychiatric Association, 2013).

The excessive use of video games is a very frequent phenomenon, especially in adolescents.

However, spending time gaming is not a sufficient condition to identify a clinical malaise or psychiatric condition.

Only a fraction of excessive gamers also show symptoms that open up the possibility of diagnosing an addiction.

Differential diagnosis of video game addiction

It is important to differentiate this disorder from ‘Internet Addiction’ and ‘Gambling Disorder’.

The former, i.e. Internet addiction, refers to the negative consequences of any activity that can be performed online (Young et al., 1999).

Thus, not only the excessive and problematic use of online or offline games as in the case of video game addiction.

The second refers to excessive and problematic involvement with games that involve betting money.

This does not apply to video games, although some of them provide the possibility of ‘unlocking’ features by paying.

The prerogative of gaming, however, remains otherwise.

Symptoms of video game addiction

The working group dedicated to studying this phenomenon states that there is still not enough evidence to support a specific diagnosis.

However, a number of possible diagnostic criteria of video game addiction are proposed to identify a risk situation:

• Strong preoccupation about the game (cognitive salience);
• Isolation behaviour when gaming is not possible;
• Tolerance (need to increase play time to experience satisfaction);
• Unsuccessful attempts to control/reduce use;
• Loss of interest in other hobbies or activities (behavioural salience);
• Excessive use despite awareness that a problem exists;
• Lies about time spent playing;
• Use of play to sedate/regulate/reduce an unpleasant emotional experience;
• Loss or impairment of relevant interpersonal relationships; Impairment of school or work performance due to gaming.

Pathological gaming, the DSM-5 considers the presence of 5 of the 9 aforementioned criteria as a threshold for identifying clinically relevant situations

It also explicitly states that the diagnostic label ‘video game addiction’ includes online (played on the Internet) and offline games.

This even though the word ‘Internet’ is included in the diagnosis of ‘Internet Gaming Disorder’.

The authors explain this apparent ambiguity by the need to distinguish video game addiction from gambling addiction (respectively ‘gaming disorder’ and ‘gambling disorder’).

Pathological gaming, diagnostic specifications

The authors of the DSM-5 also make a number of reflections and theoretical expansions on the different diagnostic criteria presented.

The preoccupation with gambling must be present at the time when the gambler is not engaged in gambling.

It must manifest itself several times a day during the same day.

Increased time spent gambling must be explained by an increased desire to gamble.

The perception of not being fulfilled by gaming sessions of shorter duration should be present.

The increase in time spent gaming does not only depend on an increase in free time (e.g. the end of school).

Other co-occurring disorders of video game addiction

People with Internet Gaming Disorder usually manifest higher levels of psychological distress (Starcevic et al., 2011).

Compared to non-pathological gamers, they have greater problems sleeping (Ahab et al., 2011) and falling asleep (Rehbein et al., 2013).

Depression is the condition that has been most frequently observed in connection with video game addiction (Desai et al., 2010; Gentile et al., 2011).

Importantly, approximately 43% of females and 13% of males affected by this addiction report suicidal ideation (Rehbein et al., 2013).

At least three studies have witnessed the association between Attention Deficit/Hyperactivity Disorder (ADHD/I) and Internet Gaming Disorder, in children, adolescents and young adults (Bioulac et al., 2008; Gentile, 2009; Walther et al., 2012).

Other authors have shown the association between video game addiction and anxiety symptoms (Gentile et al., 2011; Mentzoni et al., 2011).

Relatively few studies have investigated the relationship between Internet Gaming Disorder and other behavioural addictions. Rehbein and co-workers (2013) report that 26% of the adolescents in their sample of video game addicts also had Internet addiction (online games excluded).

Studies that finally tried to shed light on the long-term inferences of video game addiction mentioned depression and anxiety as two of the main symptomatic consequences of this addiction (Gentile et al., 2011).

Treatment of video game addiction

There are as yet no data attesting to the effectiveness of particular treatments for people suffering from this type of addiction.

Due to the diagnostic and clinical overlap with other forms of behavioural addiction, it is safe to assume that they benefit from cognitive-behavioural psychotherapeutic treatments.

These can be complemented by motivational interviewing techniques and relapse prevention strategies useful for addictions in general.

Bibliography

Achab, S., Nicollier, M., Mauny, F., Monnin, J.. Trojak, B.. Vandel, P., et al. (2011). Massively multiplayer online role-playing games: Comparing characteristics of addict vs. non-addict online recruited gamers in French adult population. BMC Psychiatry. 11, 144-154.

Bioulac, S., Arfi, L., Bouvard, M.P. (2008). Attention deficit/hyperactivity disorder and video games: A comparative study of hyperactive and control children. European Psychiatry. 23, 134-141.

Desai, RA. Krishnan-Sarin, S., Cavallo, D., Potenza, M.N. (2010). Video-gaming among high school students: Health correlates, gender differences, and problematic gaming. Pediatrics. 126, el414-e1424.

Gentile, D.A. (2009). Pathological video-game use among youth ages 8 to 18: A national study. Psychological Science. 20, 594-602.

Gentile, D.A,, Choo, H., Liau, A., Sim, T., Li, D., Fung, D., et al. (2011). Pathological game use among youths: A two-year longitudinal study. Pediatrics. 127, 319-329.

Mentzoni, R.A., Brunborg, G.S., Molde, H., Myrseth, H., Skouverge, K.J.M,, Hetland, J., et al. (2011). Problematic video game use: Estimated prevalence and associations with mental and physical health. Cyberpsychology Behavavior and Social Networking. 14, 591-596.

Rehbein, F., MòBle, T. (2013). Video game addiction and Internet addiction: is there a need for differentiation? Sucht. 59, 129-142.

Starcevic, V., Berle, D., Porter, G., Fenech, P. (2011). Problem videogame use and dimensions of psychopathology. International Journal of Mental Health Addiction, 9, 248-256.

Whalter, B., Morgenstern, M., Hanewinkel, R. (2012). Co-occurrence of addictive behaviors: Personality factors related to substance use, gambling and computer gaming. European Addiction Research. 18, 167-174.

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