Video game addiction, or more broadly used video game overuse, is excessive or compulsive use of computer and video games that interferes with daily life. Instances have been reported in which users play compulsively, isolating themselves from family and friends or from other forms of social contact, and focus almost entirely on in-game achievements rather than other life events.[1][2][3] There is no formal diagnosis of video game addiction in current medical or psychological literature. Inclusion of it as a psychological disorder has been proposed and rejected for the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).[4][5][6]
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Video game addiction is not included as a diagnosis in either the DSM or the International Statistical Classification of Diseases and Related Health Problems.
However, some scholars suggest the effects (or symptoms) of video game overuse may be similar to those of other proposed psychological addictions.[7] Video game overuse may be like compulsive gambling, an impulse control disorder.[8][9]
According to Griffiths[10]“all addictions (whether chemical or behavioural) are essentially about constant rewards and reinforcement”. Griffiths[10] believed that addiction has six components: salience, mood modification, tolerance, withdrawal, conflict, and relapse. Some scholars suggest that psycho-social dependence, if it occurs, may revolve around the intermittent reinforcements in the game and the need to belong.[10] Some scholars claim that the social dependence that may arise from video games occurs online where players interact with others and the relationships “often become more important for gamers than real-life relationships”.[11] However this is not a view which is generally accepted among all scholars.
In 2007, the American Psychiatric Association reviewed whether or not video game addiction should be added in the new DSM to be released in 2012. The conclusion was that there was not enough research or evidence to conclude that video game addiction was a disorder.[3][4][5]
A report by the Council On Science And Public Health to the AMA cited a 2005 Entertainment Software Association survey[12][13] of computer game players and noted that players of MMORPGs were more likely to play for more than two hours per day than other gamers. In its report, the Council used this two-hour-per-day limit to define "gaming overuse", citing the American Academy of Pediatrics guideline of no more than one to two hours per day of "screen time".[14] However, the ESA document cited in the Council report does not contain the two-hour-per-day data.[15]
In a 2005 Tom's Games interview, Dr. Maressa Orzack estimated that 40% of the players of World of Warcraft (an MMORPG) were addicted, but she did not indicate a source for the estimate.[16] She may have derived the estimate from the informal survey managed by Nick Yee at The Daedalus Project,[17] who notes that caution should be exercised when interpreting that data.[18] Other critics have satirized the idea of MMORPG addiction, illustrating that the genre has built-in mechanisms for burning-out players, which is contrary to the concept of addiction.[19]
A 2006 lecture reported by the BBC indicated that 12% of polled online gamers reported at least some addictive behaviours.[20][21] The lecturer, Professor Mark Griffiths of Nottingham Trent University, stated in another BBC interview that addicts are "few and far between."[22]
In 2007, Michael Cai, director of broadband and gaming for Parks Associates (a media/technology research and analysis company), said that "Video game addiction is a particularly severe problem in Asian countries such as China and Korea."[23] Results of a 2006 survey suggested that 2.4% of South Koreans aged 9 to 39 suffer from game addiction, with another 10.2% at risk of addiction.[24]
A 2007 Harris Interactive online poll of 1,187 US youths aged 8–18 gathered detailed data on youth opinions about video game play. About 81% of youths stated that they played video games at least once per month. Further, the average play time varied by age and sex, from eight hours per week (responses from teen girls) to 14 hours per week (responses by teen boys). "Tweens" (8–12-year-olds) fell in the middle, with boys averaging 13 hours per week of reported game play and girls averaging 10. Harris concluded that 8.5% "can be classified as pathological or clinically 'addicted' to playing video games", but did not explain how this conclusion was reached.[25]
Since the American Psychological Association decision in 2007, studies have been conducted at Stanford University School of Medicine related to video game play. Researchers found evidence that video games do have addictive characteristics.[26][27] An MRI study found that the part of the brain that generates rewarding feelings is more activated in men than women during video game play.[28][29]
A 2009 survey by the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario of 9,000 students from Grades 7 to 12 showed almost 10% get "screen time" for seven (or more) hours a day. A little over 10% also reported having video gaming problems in the previous year. A recent article Pediatrics (journal) found a mild association between watching television or playing a video game and attention issues in more than 1,300 children ages eight to 11 years old. Children who played video games or watched television for more than the normal two hours a day maximum, which is recommended by the American Academy of Pediatrics were 1.5 - 2 times more likely to show signs of attention issues, the researchers found. However, the study was further criticized in eLetters to the same journal for failing to use well-validated measures of attention problems or control for other important variables.[30] A more recent study using the Child Behavior Checklist and controlling for family and mental health variables, found no link between video game use and attention problems.[31] Also, a study in Pediatrics[32] found problematic gaming behaviors to be far less common, about 4%, and concluded that such problems were the result of underlying mental health problems rather than anything unique to gaming.
Writing in the American Psychological Association journal Review of General Psychology's special issue on video games, Barnett and Coulson[33] expressed concern that much of the debate on the issue of addiction may be a knee jerk response stimulated by poor understanding of games and game players. Such issues may lead both society and scholars to exaggerate the prevalence and nature of problematic gaming, and overfocus on games specifically while ignoring underlying mental health issues.
The press has reported concerns over online gaming since at least 1994, when Wired Magazine mentioned a college student who was playing a MUD for 12 hours a day instead of attending class.[34]
Press reports have noted that some Finnish Defence Forces conscripts were not mature enough to meet the demands of military life and were required to interrupt or postpone military service for a year. One reported source of the lack of needed social skills is overuse of computer games or the Internet. Forbes termed this overuse "Web fixations" and stated that they were responsible for 13 such interruptions or deferrals over the five years from 2000-2005.[35][36]
In a July 2007 article, Perth, Western Australia, parents stated that their 15-year-old son had abandoned all other activities to play RuneScape, a popular MMORPG. The boy's father compared the condition to heroin addiction.[37]
In an April 2008 article, Telegram.co.uk reported that surveys of 391 players of Asheron's Call showed that 3% of the respondents suffered from agitation when they were unable to play, or missed sleep or meals to play. The article reports that University of Bolton lead researcher Dr. John Charlton stated, "Our research supports the idea that people who are heavily involved in game playing may be nearer to autistic spectrum disorders than people who have no interest in gaming."[38]
On March 6, 2009, the CBC's national newsmagazine program the fifth estate aired an hour-long report on video game addiction and the Brandon Crisp story, titled "Top Gun", subtitled "When a video gaming obsession turns to addiction and tragedy".[39]
On August 2010, Wired Magazine reported that a man in Hawaii, Craig Smallwood, sued the gaming company NCsoft for negligence and for not specifying him that their game, Lineage II was so addictive. He alleged that he would not have begun playing if he was aware that he would become addicted. Smallwood claims to have played Lineage for 20,000 hours between 2004 and 2009.[40]
In August 2005, the government of the People's Republic of China, where more than 20 million people play online games, introduced an online gaming restriction limiting playing time to three hours, after which the player would be expelled from whichever game they were playing.[41][42] In 2006, it relaxed the rule so only citizens under the age of 18 would face the limitations.[43][44] Reports indicate underage gamers found ways to circumvent the measure.[45] In July, 2007, the rule was relaxed yet again. Internet games operating in China must require that users identify themselves by resident identity numbers. After three hours, players under 18 are prompted to stop and "do suitable physical exercise." If they continue, their characters gain 50% of the usual experience. After five hours, their characters gain no experience at all.[46]
In 2008, one of the five FCC Commissioners, Deborah Taylor Tate, stated that online gaming addiction was "one of the top reasons for college drop-outs".[47] However, she did not mention a source for the statement nor identify its position in relation to other top reasons.[47][48][49][50]
Excessive use of video games may have some or all of the symptoms of drug addiction or other proposed psychological addictions. Some players become more concerned with their interactions in the game than in their broader lives. Players may play many hours per day, having late baths and regarding personal hygiene as a waste of time, gain or lose significant weight due to playing, disrupt sleep patterns to play and suffer sleep deprivation as an effect, play at work, standing in the middle of nowhere looking into space for a considerable amount of time, avoiding phone calls from friends and/or lying about play time.[3][21] An example of this to the extreme is “A seventeen year old boy named Zach Richardson would go on streaks of fifteen hours of straight playing. He skipped meals and only stopped when he blacked out.”[51]
Other scholars have cautioned that comparing the symptoms of problematic gaming with problematic gambling is flawed, may introduce research artifacts and artificially inflate prevalence estimates. For instance Richard Wood has observed that behaviors which are problematic in regards to gambling may not be as problematic when put into the context of other behaviors that are rewarding such as gaming.[52] Similarly Barnett and Coulson have cautioned that discussions of problematic gaming have moved forward prematurely without proper understanding of the symptoms, proper assessment and consequences.[33]
Theorists focus on the built-in reward systems of the games to explain their addictive nature.[53][54] In reference to gamers such as one suicide in China, the head of one software association was quoted, "In the hypothetical world created by such games, they become confident and gain satisfaction, which they cannot get in the real world."[55]
Researchers at the University of Rochester and Immersyve, Inc. (a Celebration, Florida, computer gaming Think-tank) investigated what motivates gamers to continue playing video games. According to lead investigator Richard Ryan, they believe that players play for more reasons than fun alone. Ryan, a motivational psychologist at Rochester, says that many video games satisfy basic psychological needs, and players often continue to play because of rewards, freedom, and a connection to other players.[56]
Michael Brody, M.D., head of the TV and Media Committee of the American Academy of Child and Adolescent Psychiatry, stated in a 2007 press release that "... there is not enough research on whether or not video games are addictive." However, Dr. Brody also cautioned that for some children and adolescents, "... it displaces physical activity and time spent on studies, with friends, and even with family."[57]
Dr. Karen Pierce, a psychiatrist at Chicago's Children's Memorial Hospital, sees no need for a specific gaming addiction diagnosis. Two or more children see her each week because of excessive computer and video game play, and she treats their problems as she would any addiction. She said one of her excessive-gaming patients "...hasn't been to bed, hasn't showered...He is really a mess."[3]
Some countries, such as South Korea, China, the Netherlands, Canada, and the United States, have responded to the perceived threat of video game addiction by opening treatment centers.[24]
Because few clinical trials and no meta-analyses have been completed, research is still in the preliminary stages for excessive gaming treatment. The most effective treatments seem to be, as with addictions or dependencies, a combination of psychopharmacology, psychotherapy and twelve-step programs.[58]
The Chinese government operates several clinics to treat those suffering from overuse of online games, chatting and web surfing. Treatment for the patients, most of whom have been forced to attend by parents or government officials, include various forms of pain or uneasiness.[59][60] In August 2009, Deng Sanshan was reportedly beaten to death in a correctional facility for video game and Web addiction.[61]
In June 2006, the Smith and Jones Clinic[62] in Amsterdam became the first treatment facility in Europe to offer a residential treatment program for compulsive gamers.[63] Keith Bakker, founder and head of the clinic, has stated that 90% of the young people who seek treatment for compulsive computer gaming are not addicted.[64] The clinic focuses on excess gaming being a result of social situations rather than an addictive dependency.
McLean Hospital in Belmont, Massachusetts has set up Computer Addiction Services.[65] Elsewhere, gamers may seek services at generalized addiction support centers.
Online Gamers Anonymous, an American non-profit organization formed in 2002, is a twelve-step, self-help, support and recovery organization for gamers and their loved ones who are suffering from the adverse effects of excessive computer gaming. The organization provides a variety of message boards, daily on-line chat meetings, a Saturday and Wednesday Skype meeting, and other tools for healing and support.
In July 2009, ReSTART, a residential treatment center for "pathological computer use", opened in Fall City, near Seattle, Washington.[66]
www.gamingaddiction.net, was formed in 2011 to promote responsible gaming including internet games, online gambling, and fantasy sports. They offer surveys for gamers and people that care about gamers. They advocate a simple three pronged approach to responsible gaming: Understand what gaming is; Solve problems that are created by excessive gaming; act out the solution and live a healthier life free of gaming addiction.
At a Computer Addiction Services[65] center in Richmond, British Columbia, excessive gaming accounts for 80% of one youth counselor's caseload.[67]
Globally, there have been deaths caused directly by exhaustion from playing games for excessive periods of time.[68][69] There have also been deaths of gamers and/or others related to playing of video games.
In 2007, it was reported that Xu Yan died in Jinzhou after playing online games persistently for over 2 weeks during the Lunar New Year holiday.[70] Later 2007 reports indicated that a 30-year-old man died in Guangzhou after playing video games continuously for three days.[71][72]
The suicide of a young Chinese boy in the Tianjin province has highlighted once more the growing dangers of game addiction, when those responsible do not understand or notice the risks of unhealthy play. Xiao Yi was thirteen when he threw himself from the top of a twenty-four story tower block in his home town, leaving notes that spoke of his addiction and his hope of being reunited with fellow cyber-players in heaven. The suicide notes were written through the eyes of a gaming character, so reports the China Daily, and stated that he hoped to meet three gaming friends in the after life. His parents, who had noticed with growing concern his affliction, weren't mentioned in the letters.[55]
In March 2005, the BBC reported a murder in Shanghai, when Qiu Chengwei fatally stabbed fellow player Zhu Caoyuan, who had sold on eBay a dragon saber sword he had been lent in a Legend of Mir 3 game,[73] and was given a suspended death sentence.[74]
In 2005, Seungseob Lee (Hangul: 이승섭) visited an Internet cafe in the city of Taegu and played StarCraft almost continuously for fifty hours. He went into cardiac arrest, and died at a local hospital. A friend reported: "...he was a game addict. We all knew about it. He couldn't stop himself." About six weeks before his death, his girlfriend, also an avid gamer, broke up with him, and he had been fired from his job for repeated tardiness.[75][76][77]
In 2009, Kim Sa-rang, a 3-month-old Korean child, died from malnutrition after both her parents spent hours each day in an internet cafe raising a virtual child on an online game, Prius Online.[78]
An Earthtimes.org article reported in 2007 that police arrested a 13-year-old boy accused of murdering and robbing an 81-year-old woman. A local policeman was quoted as saying that the boy "...confessed that he needed money to play online games and decided to kill and rob..." the victim. The article further related a police report that the murder by strangling netted the thief 100,000 Vietnamese dong (US$6.20).[79][80]
In February 2002, a Louisiana woman sued Nintendo because her son died after suffering seizures caused by playing Nintendo 64 for eight hours a day, six days a week. Nintendo denied any responsibility.[81]
In August 2004, Troy Victorino and three accomplices entered a home on Telford Lane in Deltona, FL and tortured and murdered Erin Belanger and 5 other people who were in the home at the time of the attack. Victorino's motive for the attack was to retrieve his Xbox, which Belanger had not returned after evicting Victorino from the home before the attack.[82]
Press reports in November 2005 state that Gregg J. Kleinmark, 24, pleaded "guilty to two counts of involuntary manslaughter". He "left fraternal twins Drew and Bryn Kleinmark unattended in a bathtub for 30 minutes, in order to go three rooms away and play on his Game Boy Advance" while "in the mean time, the two ten-months old kids drowned".[83][84]
A New Mexico woman named Rebecca Colleen Christie was convicted of second degree murder and child abandonment, and sentenced to 25 years in prison, for allowing her 3 and a half-year-old daughter to die of malnutrition and dehydration while occupied with chatting and playing World of Warcraft online.[85]
Tyrone Spellman, 27, of Philadelphia, was convicted of third-degree murder for killing his 17-month old daughter in a rage over a broken Xbox.[86]
In November 2008 Shawn Woolley committed suicide due to the popular computer game Everquest. Shawn’s mother said the suicide was due to a rejection or betrayal in the game from a character Shawn called “iluvyou”.[87]
Ohio teen Daniel Petric shot his parents, killing his mother, after they took away his copy of Halo 3 in October 2007. In a sentencing hearing after the teen was found guilty of aggravated murder, the judge said, "I firmly believe that Daniel Petric had no idea at the time he hatched this plot that if he killed his parents they would be dead forever."[88][89] On 16 June 2009, Petric was sentenced to 23 years to life in prison.[90][91]
In Jacksonville, Florida, Alexandra Tobias pleaded guilty to second-degree murder for shaking her baby to death. She told investigators that the baby boy's crying had interrupted her while she was playing a Facebook game called FarmVille. She was sentenced in December 2010.[92]
In November 2010 in South Philadelphia, Kendall Anderson, 16, killed his mother for taking away his PlayStation by hitting her 20 times with a claw hammer while she slept.[93]
Brandon Crisp, an Ontario 15-year-old, ran away from home on Thanksgiving Monday in 2008 after his parents took away his Xbox 360 due to falling grades and excessive play of Call of Duty 4: Modern Warfare.[94] He was last seen alive on a bicycle trail. His body was found 3 weeks later, about three miles away, by a party of hunters.[95] An autopsy determined that he died when he fell from a tree.[96]
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