Is Gaming addictive?

I put this question to a group of 12 year old boys and to a group of parents. As to be anticipated, the points of view of the two groups were passionately opposed.

The boys felt that gaming was a valid hobby and that the top gamers are akin to top sportsman. (Indeed, it is proposed as a 2024 Summer Olympics gaming event). They said that gaming was a sociable stress reliever, that it kept their reflexes fast and their thinking faster. I must confess, I posed the question to a particularly nice and well-adapted group of boys. They were very fired up about the topic and made valid points.

Their parents were less enthusiastic (except for one parent, who was an avid gamer in his own right and felt gaming helped him bond with his adolescent sons.) The rest of the parents were concerned about the addiction potential. They have witnessed the tantrums when they tell their kids to get off screen-time. What is all this screen time doing to our kids’ brains?

This question is being heavily debated in psychiatry. The European diagnostic criteria, the ICD 11, and the World Health Organisation have just included “Gaming Disorder” as a disorder. The American diagnostic criteria, the DSM 5, has not included gaming as a disorder. The DSM 5 only has one behavioural addiction- gambling.

So, are video games addictive, or aren’t they?

Video games use state of the art behaviour psychology to keep you playing. They are designed to be an immersive experience. Hours can pass without notice. It is a world where you are safe and in control, one where you get used to instant gratification. Some games make use of manipulative game designs such as in-app purchases and loot boxes which can be likened to gambling.

In the brain during gaming, there are repeated dopamine spikes. Dopamine is one of the neurotransmitters which floods the brain when drugs like ecstasy or cocaine are used. With prolonged exposure, the brain could change its structure. There is hyperfocus on gaming (craving), numbing of everyday pleasures and erosion of willpower. In short, the same changes which occur in an addict’s brain. No wonder parents are worried.

The kids have valid points too. Just because you enjoy gaming, doesn’t mean that you are addicted. Anybody who is dedicated to their hobby will be passionate about it and spend a lot of time on it. To call it an addiction would be pathologising normal, healthy behaviour.

In my practice, I hold these two views when I assess a patient. In most cases, there is absolutely nothing wrong with gaming. However, if there has been a decline in functioning, I get worried. Is gaming the only thing of interest, taking precedence over other activities like socialising or exercise? Is it all they think about? Have grades dropped? Has there been deceit around the gaming?

In countries like Japan, there is even a name for it: hikikomori. Hikikomori refers to someone who spends all their time gaming until they are anxious about going out into the real world. They are typically described as pale, sleep-deprived, poorly nourished and poorly toned from lack of movement. Clearly, it is easy to say that there is a problem in such cases.

But is that problem addiction? Could it be that “addicted” patients are using gaming to escape uncomfortable feelings such as depression or difficult situations such as bullying? Comorbidity, the coexistence of two or more disorders, is common in psychiatry. It could be both addiction and depression.

I don’t think parents need to worry too much. The prevalence of gaming addiction is one to four per cent. Ultimately we have the power. If the gaming is getting out of hand, we turn off the wifi until after homework, sport, socialising, the room is tidy and attitude is improved.

If setting limits proves to be a bit harder than that, there is help available. From (ironically) online resources for parents and children to treatment centres for addictions. With the inclusion of gaming as a disorder, there will be more and more resources made available to manage it.