Gaming disorder: The rise of a 21st century epidemic
Increased connectivity and immersive technology has created a new level of computer gaming – but it has also created a new disease. Here's a look inside its first UK clinic.
Lee Seung Seop loved playing World of Warcraft. You might say that he was ‘addicted’ to this online video game. Every day, after finishing his job as a boiler repairman in the South Korean city of Daegu, this 28-year-old would head straight for a nearby Internet café, before losing himself for countless hours in his hobby.
As his addiction increased, he would regularly forget to drink and eat; he turned up late for work so many times that eventually his manager sacked him. His girlfriend, also a keen gamer, split up with him.
Six weeks later, in August 2005, Lee embarked on a binge session of another video game called Starcraft. He played for over 50 hours, as usual failing to eat or drink enough. Finally, he keeled over in his chair, and was rushed to hospital where he died a few hours later. The cause of death was heart failure brought on by dehydration and exhaustion.
Although rare, there are other horror stories concerning addiction behaviour related to gaming. The Chinese boy, for example, who committed suicide after a 36 hour gaming marathon in the hope that he’d meet his gaming friends in the afterlife. Or the American teenager Daniel Petric who, in 2007, shot his parents because they confiscated his copy of the first-person shooter game Halo 3. Or the South Korean baby who, in 2009, died from malnutrition when her parents ignored her through their gaming addiction.
Recognition and definition
In May 2019 the World Health Organisation officially classified gaming addiction as a disease. Britain’s NHS is aware of the severity of the problem, too. In November 2019 it launched the National Centre for Gaming Disorders. Based in a large Victorian townhouse in west London, the centre is headed up by its director Professor Henrietta Bowden-Jones, supported by a staff of seven psychologists, psychiatrists and therapists. Its aim is to treat 13 to 25-year-olds. So far the lion’s share of patients have been young males.
All the evidence suggests gaming addiction is primarily a young, male disease. The acuteness of the problem is difficult to measure, though. There are no internationally agreed statistics on how many people suffer from gaming disorders. The World Health Organisation definition is rather vague. “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,” they state.
“By switching off, players feel they are letting down their peers, or alienating their friends, and risking not being picked for a team in the future.”
Bowden-Jones explains how many people – not just gamers – are prone to excessive screen time, bingeing on Netflix box sets for days on end, for example. Her patients, however, are far worse than that. “When we talk about losing control, we’re not talking about a week or two,” she adds. “We’d expect problems to have lasted for a year or so.”
According to the Association for UK Interactive Entertainment (UKIE), the country’s leading trade association for the video game industry, Britain is the sixth largest market in terms of video game consumer revenue, behind China, South Korea, USA, Japan and Germany. It says there are 37.3 million people regularly playing video games in this country, but it has no reliable figures on how many of those suffer from disorders.
Bowden-Jones bemoans the fact there is so little research in the field. She points to recent studies that suggest around six per cent of Britons suffer from disorders. However, she feels this figure may be too high, and that some of the screening tools used to measure disorders are overstating the problem.
So which are the games most commonly addictive? Bowden-Jones and her colleagues are at pains not to single out individual game names, however, they say the three genres their patients are struggling with are multi-player online battle arena games (MOBA), massively multi-player online role-playing games (MMORPG) and Battle Royale games (where players fight to be the last person standing).
Cause and effects
There are many reasons why gamers become addicted. Teresa Pacchiega, family therapist at the National Centre for Gaming Disorders, points out how the multi-player online games allow users to play 24 hours a day with peers in other time zones all over the planet. “Some games don't have a time frame for you to achieve a level so you just keep going and going. That's an incentive not to stop.”
Bowden-Jones points out the team element of many of these games. By switching off, players feel they are letting down their peers, or alienating their friends, and risking not being picked for a team in the future.
Rebecca Lockwood, a clinical psychologist at the centre, believes the escapism and role identities offered by video games can be addictive. “I think there’s a lot of social anxiety in young people who are gaming. Gaming is a safe space; you can create a new identity for yourself.”
Centre psychiatrist Mario Santos points to a phenomenon called the sunk cost fallacy. “If you invest a lot of time in an activity, you are more willing to invest further time. So if you have played for 40 hours, you want to continue, despite the negative effects.”
Another major addictive factor is what’s called loot box, where players can win or buy virtual rewards such as weapons, treasure or clothing for their avatars. This has attracted much negative attention because of its similarity to gambling. Bowden-Jones and her colleagues want loot boxes to be regulated by the UK Government’s Gambling Commission, so as to put them beyond the reach of children. “I don't think loot boxes can last much longer without stringent regulation,” she adds. The Belgian government banned loot boxes in 2018.
The psychological consequence
The psychological effects of gaming addiction are similar to those of other addictions. Bowden-Jones explains how one key area of the brain affected is the ventromedial prefrontal cortex in the frontal lobe. “It means [gamers] have impaired decision making, impaired response to rewards, and very high levels of impulsivity,” she says.
As with drug addictions, video gaming releases dopamine into the brain. “The dopamine habituates, so you need more to achieve a baseline that gives you satisfaction,” Lockwood explains.
“Our observations suggest that some patients are people who inter-personally have less than perfect lives. They might be bullied at school, or have complex relationships, so their only way to relate with others is online. But others might be extremely competent, top of their class, top of their sports teams and very competitive people. This group of people transfer their competitiveness to online games and then start to fall back in their real-life achievements because they've switched their focus.”
“Some games don't have a time frame for you to achieve a level so you just keep going and going. That's an incentive not to stop.”
There are physical problems for gaming addicts, too. As with any sedentary activity, exercise and nutrition take a back seat, sometimes causing severe weight loss or weight gain.
Recovery tactics
Once patients present themselves, the treatment offered by the centre focuses strongly on cognitive behaviour therapy. The therapists attempt to understand the emotions and triggers that cause each gamer to become addicted, and then challenge the “beliefs and thought processes that lead to problem gaming behaviour”.
After this they suggest ways patients can reward themselves in ways other than by gaming. “You need to understand exactly what they get from the games so you can help them replicate that in real life,” says Pacchiega. Finally, they help patients develop their communications skills and work on inter-personal relationships.
Bowden-Jones admits that only one of her colleagues – Mario Santos – plays video games regularly. He has been invaluable in lecturing his co-workers on “the practical aspects of gaming, game classifications and sub-genres”. The rest of the team, meanwhile, is intensifying its research by watching gamers interact on YouTube. The centre itself, however, is very much a video game-free zone.
“As a group, we are not great gamers,” Bowden-Jones says. “But we have met with many gamers. Not pathological ones but high-frequency gamers who understand the drives, cravings and rewards that they experience in normal but certainly high-input behaviour. It’s been very helpful to us.”
She stresses how they have learned to understand the psychology of the various games that people play. “What features of games drive people to play for longer; how gamers respond to in-game features in specific ways.”
Bowden-Jones is confident the treatment offered by her centre can help even the most serious addicts. If only an addiction centre like this had been available to the South Korean player Lee Seung Seop. It might have saved his life.
