II. Epidemiology
- Video game play Prevalence: 205 Million (two thirds of U.S population)
- Up to 50% of those who game, report problematic use
III. Pathophysiology
- Video game play has positive benefits in moderation
- Recreational gaming can connect players with family and friends
- May increase socialization and increase interpersonal relationships
- May give temporary respite to more stressful external experiences
- May improve cognitive processing, juggling tasks and in some cases offer education
- Excessive gaming has adverse effects
- Dependence and addiction at the expense of relationships and responsibilities
- Altered neurobiological pathways during development (childhood and teen years)
- Increased craving of video game stimulation diverts attention from reality
- Associated with poor academic performance and poor grades
- Adverse mental health effects, including Insomnia, Major Depression and Suicidal Ideation
- Associated with unhealthy habits (poor diet, lack of Exercise, poor hygiene) and Obesity
IV. Risk Factors
- Adolescents (extending into young adulthood)
- Attention-deficit hyperactivity disorder
- Mood Disorders (Major Depression, Anxiety Disorder)
- Developmental Disability
V. Diagnosis: Gaming Disorder
- Causes significant Impairment in patient's life
- Criteria (2 of 3 criteria for at least 12 months)
- Impaired control over gaming (onset, frequency and intensity)
- Increased priority given to gaming (takes precedence over other life interests, daily activities)
- Continuation or escalation of gaming despite negative consequences
VI. Diagnosis: Internet Gaming Disorder
- Causes significant Impairment in patient's life
- Criteria (5 of 9 criteria for at least 12 months)
- Salience
- Thinking about previous gaming activity
- Anticipating playing the next game
- Gaming tolerance
- Increased hours spent gaming
- Mood modification
- Gaming used to escape or relieve negative mood (e.g. guilt, anxiety)
- Relapse
- Unsuccessful attempts to stop or reduce gaming time
- Withdrawal symptoms
- Irritability or anxiety when games are removed
- Conflict
- Loss of interest in real life relationships, hobbies, Physical Activity or other entertainment
- Deception
- Deception of gaming activities to family, therapists and others
- Problems
- Continued excessive gaming despite knowledge of negative consequences
- Lost opportunities
- Jeopardized or lost relationships, jobs, education or career opportunities due to gaming
- Salience
VII. Evaluation
- Screen for Digital Dependency and Gaming Disorder at routine visits
VIII. Management
- Manage comorbid mental health and lifestyle concerns
- Consider social support groups
- Consider formal mental health specialist referral (e.g. Cognitive Behavioral Therapy)
- Acute distress (esp. with comorbid mental health conditions)
- Refractory course
-
Motivational Interviewing
- See Motivational Interviewing (Five Rs Technique)
- Relevance
- How many hours a day do you spend gaming?
- What types of games do you play?
- Risks
- Are you aware of your gaming addiction?
- Have you had problems because of your gaming (e.g. school grades, work performance)?
- Rewards
- Why do you enjoy playing video games?
- Roadblocks
- Are you motivated to make a change?
- What life stressors do you have currently that would prevent change?
- Repeat
- Readdress at each visit with an unmotivated patient
IX. Prevention
- See Digital Dependency
- See Social Media Use in Adolescents
- Discuss complications of Gaming Disorder and Internet Gaming Disorder
- Family Media Plan
- See Digital Dependency for age specific guidelines
- Consistent guidelines for gaming and media across all household members (including parents)
- Limit recreational Screen Time to <1-2 hours/day
- Promote alternative activities (e.g. social activities, Exercise and sports)
- Emphasize future goals and academics
- Take breaks from gaming
- Physical Activity
- Relieve Dry Eyes and eye strain
- Social interaction
X. Complications
- Mental health disorders (e.g. Mood Disorders, Suicidality)
- Poor school performance and poor grades
- Lack of social skill development
- Unhealthy lifestyle and Obesity Risk
- Insomnia
- Dry Eyes
XI. Resources: Game Ratings for Violence and other problematic themes
- Entertainment Software Rating Board (ESRB)
- Nintendo Switch Parental Controls
- Playstation Family Account Setup
- Steam Families User Guide