Problematic Digital Gaming: Prevalence and Identification

Gaming is a popular leisure activity. 60.5 percent of Finnish 10- to 75-year-olds play digital games every month. Young people, i.e. 10- to 19-year-olds, play more actively and a wider variety of games, and 69.8
percent of them play digital games weekly. For some gamers, digital gaming is compulsive, and they may have difficulties in controlling the time spent on gaming. In these cases, gaming may be harmful to the person’s health, well-being and ability to function, and affect their school or work life and social relationships. Various terms have been used to refer to this problematic behaviour, such as gaming addiction, excessive gaming, gaming disorder and problematic digital gaming.

In this article, we use the term ‘problematic digital gaming’ to refer to this phenomenon, which covers gaming problems varying from mild symptoms to a severe disorder that harms the person’s life management and ability to function. The terms ‘internet gaming disorder’ (IGD) or ‘gaming disorder’ are used when referring to gaming as a potential medical diagnosis.

Problematic digital gaming and internet gaming disorder

Discussions around problematic digital gaming were fuelled when the American Psychiatric Association (APA) included internet gaming disorder in its latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1] as a potential diagnosis that requires further study. This type of recognition in the DSM-5 means that further research is needed to define the criteria for the diagnosis as well as to understand how problematic gaming develops and how permanent its harmful effects are. In June 2018, the World Health Organization (WHO) included gaming disorder in its International Classification of Diseases (ICD-11) for the first time, giving it the status of an official disease.

In these classifications, digital gaming is considered problematic when the gamer has started to lose control over it, spends significantly more time on gaming than before and experiences negative impacts related to gaming for at least 12 months. Problematic gaming can be caused by both online and offline digital gaming. In research, three common characteristics have been found for problematic gaming. These are withdrawal symptoms, loss of control and interpersonal conflicts [2].

The WHO defines gaming disorder as a permanent and repeated behaviour in which the person is unable to control the frequency, duration and content of their gaming. The person also prioritises gaming over their other daily activities and areas of interest. Despite the negative effects and awareness of them, the person also continues gaming and spends more time gaming.

If the harmful effects of gaming are severe enough, intervention may be necessary even before the required period of 12 months. To reduce the risk of over-diagnosing, the WHO’s gaming disorder diagnosis includes the criterion that gaming has significantly reduced the person’s ability to function. In this classification, digital gaming is examined comprehensively in relation to the person’s ability to function and life in general.

While the APA does not yet recognise internet gaming disorder as an official condition, it has identified nine main symptoms of internet gaming disorder [1]. These are

1. Extreme preoccupation with gaming,
2. Withdrawal symptoms when not gaming, such as restlessness and irritability,
3. Continuous need to spend increasing amounts of time gaming,
4. Unsuccessful attempts to control internet gaming,
5. Giving up other activities such as hobbies due to gaming,
6. Continued excessive internet gaming despite awareness of its negative effects,
7. Deceiving other people about the amount of gaming,
8. Playing internet games to relieve or escape negative moods, such as guilt or anxiety, and
9. Jeopardising or losing an important relationship, job, education or career due to internet gaming. The diagnosis of internet gaming disorder requires that the person repeatedly experiences five or more of these symptoms within a year.

The above-mentioned nine criteria for internet gaming disorder have been developed based on research on substance and gambling addiction, and for this reason they have also been criticised. Unlike gambling and substance abuse, internet gaming is one of the most popular leisure activities among young people, and it is easy to spend time on gaming. When discussing the challenges of determining problematic gaming, it has been pointed out that the younger generations’ entertainment and communication activities increasingly take place in digital environments. As a result of this, it is natural that these activities also absorb their thoughts to a greater degree. Furthermore, some researchers consider the criterion of withdrawal symptoms related to reducing or stopping gaming ambiguous, because it does not consider the duration of the symptoms.

Identifying and assessing problematic digital gaming

The concept and nature of problematic digital gaming and the ways to determine it have spurred lively debates both in the media and among researchers in the field. Over the years, the variety of interpretations concerning the phenomenon has led to the development and testing of new diagnostic assessment tools. Most of the measures developed are targeted specifically at adolescents and young adults. Examples of measures used in Finnish studies include the Internet Gaming Disorder Test (IGDT-10, [4]) and Problematic Online Gaming Questionnaire (POGQ, [3, 5]).

The questions of the POGQ are related to six different dimensions of problematic gaming, which are 1) Preoccupation, 2) Overuse, 3) Immersion, 4) Social isolation, 5) Interpersonal conflicts and 6) Withdrawal. The purpose of the questionnaire is to measure factors such as the extent to which gamers experience these dimensions and how often within the past year (Table 2, [5]). The POGQ was developed for research use, and we describe it here for the purpose of illustrating the symptoms of problematic digital gaming and the assessment of their prevalence. While the questionnaire helps to identify potential symptoms of problematic digital gaming, it should not be used to diagnose gaming disorder as such.

The questions and dimensions of the POGQ

1. When you are not gaming, how often do you think about playing a game or think about how it would feel to play at that moment? (Preoccupation)
2. How often do you play longer than originally planned? (Immersion)
3. How often do you feel depressed or irritable when not gaming only for these feelings to disappear when you start playing? (Withdrawal)
4. How often do you feel that you should reduce the amount of time you spend gaming? (Overuse)
5. How often do the people around you complain that you are gaming too much? (Interpersonal conflict)
6. How often do you fail to meet up with a friend because you were gaming? (Social isolation)
7. How often do you daydream about gaming? (Preoccupation)
8. How often do you lose track of time when gaming? (Immersion)
9. How often do you get irritable, restless or anxious when you cannot play games as much as you want? (Withdrawal)
10. How often do you unsuccessfully try to reduce the time you spend on gaming? (Overuse)
11. How often do you argue with your parents and/or your partner because of gaming? (Interpersonal conflict)
12. How often do you neglect other activities because you would rather game? (Social isolation)
13. How often do you feel time stops while gaming? (Immersion)
14. How often do you get restless or irritable if you are unable to play games for a few days? (Withdrawal)
15. How often do you feel that gaming causes problems for you in your life? (Overuse)
16. How often do you choose gaming over going out with someone? (Social isolation)
17. How often are you so immersed in gaming that you forget to eat? (Immersion)
18. How often do you get irritable or upset when you cannot play? (Withdrawal)

Problematic digital gaming has also been examined using theories that explain the meanings of gaming. Some experts view problematic digital gaming as deriving from a naturally addictive behaviour. In addition to the addiction approach, problematic digital gaming has also been explained as a difficulty in self-regulation and controlling compulsive thoughts and actions, or as compensatory action that focuses on technology. The gamer resorts to digital gaming as a compensatory way of dismissing uncomfortable and disturbing real-life situations and challenges, and the sensations they produce. In these situations, the person has problems with life management. People with mental health problems are especially at risk of developing gaming disorder. Thus, in some cases, problematic digital gaming may be a symptom of an underlying psychosocial condition.

Problematic digital gaming has also been analysed by psychologists in the context of self-determination theory. According to this approach, those persons who can sufficiently fulfil their basic psychological needs elsewhere in life, outside digital gaming, are less prone to become preoccupied with digital gaming to the extent that it becomes a problem. The basic psychological needs include autonomy (choices and self-expression), competence (ability to function the way one wants) and relatedness (belonging to a group, experience of being accepted) [6]. Satisfaction in life promotes people’s health and may protect them from the development of problematic digital gaming.

Potential negative effects related to problematic gaming and gaming disorder

Gamers may experience symptoms of problematic or excessive gaming for a short time, after which they pass. What is thus essential when determining problematic digital gaming and gaming disorder is to examine the duration of the negative effects and symptoms. With gaming disorder, the gamer arranges more opportunities for gaming for themselves, and the gaming hobby takes up more and more time from other important areas of life and other leisure activities. If problematic gaming behaviour continues for several months, it may have a significant negative impact on the person’s psychosocial situation and ability to function. On the other hand, playing a new game or playing with new gaming friends may also temporarily capture a person’s attention fully. The gamer or people close to them may experience short-lived or temporary negative effects from gaming, but this does not mean that the person has gaming disorder and that there is reason for concern. Still, younger gamers in particular need proactive guidance from their parents concerning their gaming behaviour. Agreeing on common rules and supervising them helps children to understand what is expected of them.

It would be important to reach a common understanding on the criteria for gaming disorder to enable the development of treatments and assessment of their efficiency. Based on current research knowledge, some negative effects related to problematic digital gaming have been identified, such as depression, anxiety, social phobia, low self-esteem, neuroticism, aggression or hostility, social isolation, concentration problems, loneliness and generally lower psychosocial well-being [7]. One longitudinal study has also suggested that problematic digital gaming has caused symptoms of for example depression and anxiety. It remains unclear, however, whether these negative symptoms are the causes or the effects of problematic digital gaming. There is also evidence of cases where gamers’ depressive and anxious symptoms have preceded the symptoms of problematic digital gaming. [8] Nevertheless, what is typical of problematic digital gaming is the co-occurrence of several negative psychosocial symptoms. The analysis and treatment of these symptoms and rehabilitation should be modified according to the gamer’s situation in life, environment, social relationships and overall well-being.

The prevalence of problematic digital gaming

The data on the prevalence of problematic gaming varies due to the variety of assessment measures as well as their theoretical background, empirical validation, limit values and sample sizes. A small part of the studies represents population research, and some of these studies focus on players of digital games. Most prevalence studies have focused on adolescent and young adult gamers aged between 13 and 24. For example, according to one review article based on 37 cross-sectional studies, the prevalence of problematic digital gaming varied between 0.7 and 27.5 percent in different data sets [9]. In most of the studies, problematic digital gaming was more prevalent in men than in women, and younger gamers were at a higher risk of developing problematic behaviour compared to older gamers. The values of prevalence of the phenomenon have also varied according to geographical areas. For example, in countries of East and South Asia, 10 to 15 percent of young people have experienced this problem. In European and North American countries, on the other hand, the prevalence of problematic digital gaming has varied from less than 1 to 10 percent, but in most countries it has varied between 1 and 5 percent among young people.

According to a study among Finnish pupils, approximately 1 percent of young people who play digital games experience severe symptoms of problematic digital gaming. 9 percent of them show various negative effects of problematic digital gaming and an increased risk of developing a more severe gaming disorder [3].

Problematic digital gaming or gaming disorder can be diagnosed in individuals only through in-depth clinical interviews. On the other hand, awareness of the phenomenon and the existence of criteria for recognising the problem make it possible to develop different models of guidance and support as well as to appropriately focus support on those gamers who need help.

References

[1] APA. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition. Washington, USA. 2013.

[2] King, D. L., Haagsma, M. C., Delfabbro, P. H., Gradisar, M. & Griffiths, M. D. Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review. 2013, vol 33:3, 331–342.

[3] Männikkö, N., Ruotsalainen, H., Demetrovics, Z., Lopez-Fernandez, O., Myllymäki, L., Miettunen, J. & Kääriäinen, M. Problematic Gaming Behavior Among Finnish Junior High School Students: Relation to Socio-Demographics and Gaming Behavior Characteristics. Behavioral Medicine. 2017, 1–11.

[4] Männikkö, N., Ruotsalainen, H., Tolvanen, A., & Kääriäinen, M. Psychometric properties of the Internet Gaming Disorder Test (IGDT-10) and prevalence of problematic gaming behavior among Finnish vocational school students. Scandinavian Journal of Psychology. 2018.

[5] Männikkö, N., Demetrovics, Z., Ruotsalainen, H., Myllymäki, L., Miettunen, J., & Kääriäinen, M. Psychometric Properties of the Problematic Gaming Questionnaire Used to Assess Finnish Adolescents. International Journal of Mental Health and Addiction. 2018, 1–9.

[6] Deci, E. L. & Ryan, R. M. The “what’” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychological Inquiry. 2000, vol 11:4, 227–268

[7] Männikkö, N., Ruotsalainen, H., Miettunen, J., Pontes, H. M. & Kääriäinen, M. Problematic gaming behaviour and health-related outcomes: A systematic review and meta-analysis. Journal of Health Psychology. 2017.

[8] Gentile, D. A., Choo, H., Liau, A., Sim, T., Li, D., Fung, D. & Khoo, A. Pathological Video Game Use Among Youths: A Two-Year Longitudinal Study. PEDIATRICS. 2011, vol 127:2, 319–329.

[9] Mihara, S., & Higuchi, S. Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature. Psychiatry and Clinical Neurosciences. 2017, vol 71:7, 425–444.

[10] Männikkö, N., Billieux, J., & Kääriäinen, M. (2015). Problematic digital gaming behavior and its relation to the psychological, social and physical health of Finnish adolescents and young adults. Journal of Behavioral Addictions, 4(4), 281–288.