Internet Gaming Disorder: A Case for Addiction?

Internet Gaming Disorder: A case for addiction?

Abstract

The inclusion of Internet Gaming Disorder (IGD) in the ‘Emerging Measures and Models’ section of the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) highlights it as a promising area of research to be considered for formal inclusion in future editions of the DSM.  This consideration is representative of a change in clinical perceptions of addiction, with behavioural addictions currently presenting a rapidly growing area of research interest.  This paper provides a brief overview of IGD and considers its case for formal recognition as a standalone addictive disorder by comparing it with established evidence which is presented in the case of substance addictions.  Biological, psychological, and sociological factors are considered, which identify a significant overlap between the features of IGD and substance addiction, subsequently providing a strong case for its consideration.  However, this case is undermined by a lack of reliability and validity across IGD research due to inconsistent methodological approaches.  Therefore, it is concluded that until a body of evidence is produced which is cross-culturally valid and reliable, IGD may struggle to be considered as a standalone addictive disorder.

Introduction

Background

Gaming is one of the most popular and rapidly growing activities in the world today, and it was estimated that there were 1.2billion people (17% of the world population) playing games globally in 2013, with numbers only set to rise (Spilgames, 2013).  Much of this rise in popularity can be largely attributed to the recent developments of online gaming, with 44% (700million) of the world’s 1.6billion online community playing online games (Spilgames, 2013).  Generally, gaming at reasonable levels is not considered to be harmful and has even been shown to have positive effects (Wilms, Petersen & Vangkilde, 2013).  However, there does appear to be a growing number of individuals who are engaging in uncontrolled and problematic gaming behaviours (Gentile, 2009).  In-line with these developments, research into online addictions has grown considerably over the past two decades (Kuss et al., 2014), and much of it has concentrated on problematic gaming (Griffiths, Kuss & Pontes, 2016).  

In the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association (APA), 2013) Internet Gaming Disorder (IGD) was included in Section 3 (Emerging Measures and Models) as a promising area of research warranting additional study.  This is just one such area in which research is recognising certain behaviours that can resemble drug dependence, and which are warranting consideration as non-substance or “behavioural” addictions (Karim & Chaudri, 2012).  Excessive engagement in gambling, internet-use, gaming, sex, eating, exercise, and shopping, among others, may represent behavioural addictions (Holden, 2010), as a significant minority of individuals involved in these behaviours exhibit habitual or compulsive engagement (Grant, Schreiber & Odlaug, 2013).

Addiction

It was until only recently, that the use of the term “addiction” in clinical practice was one exclusively reserved for the description of drug related disorders.  However, over the past few years the concept of addiction, or what constitutes addiction, appears to have shifted somewhat, which has in turn allowed for its application in a broader context.  This shift is reflected in the definition proposed by West and Brown (2013) who describe addiction as: “a chronic condition in which there is a repeated powerful motivation to engage in a rewarding behaviour, acquired as a result of engaging in that behaviour, that has significant potential for unintended harm”.  This consideration of behaviour, as opposed to solely drugs, in defining addiction has since given rise to the concept of non-substance or “behavioural” addictions, which are now included in the DSM-5 (APA, 2013) and the ICD-10 (International Classification of Disease; WHO, 2016).  The idea that addictions could exist in the absence of drugs was first popularised by Peele and Brodsky in 1979, however, it is only now becoming popularly regarded, in contrast to previously held beliefs, that any source which is capable of stimulating an individual has the potential to become an addiction (Alavi et al., 2012).  

The aim of this paper is to critically consider the case for IGD as an addiction by consulting the current literature and comparing the evidence for IGD as an addiction with that which is widely known and accepted in the case of drug addiction.

Diagnostic criteria

At present, disordered gambling is the only behavioural addictive disorder included in the main body of the DSM-5 (APA, 2013).  However, IGD’s inclusion in section 3 of the manual identifies it as a potential candidate for future inclusion in the addictions category.  Defining what constitutes addiction however, still remains an issue of some debate (Alavi et al., 2012), although it is commonly agreed that central to its definition is a dependence on a substance or activity (Widyanto & McMurran, 2004).  It is important to distinguish dependence from addiction as the two are often used interchangeably (West & Brown, 2013).  Dependence can be characterised physically by symptoms of tolerance and withdrawal, and psychologically, by the formation of conditioned emotional responses known as “triggers”, to events, places, people, feelings, or anything that a person may associate with a particular substance or behaviour (Smith, 2016).  Addiction, on the other hand, can be characterised by features such as: continued engagement in a behaviour despite adverse consequences, diminished self-control over engagement in a behaviour, compulsive engagement in a behaviour, and an appetitive urge or craving state prior to engaging in the behaviour (Potenza, 2006; Shaffer et al., 2004; Wareham & Potenza, 2010).  While dependence is central to defining addiction, it is possible for a person to have dependence without addiction (Smith, 2016).

The DSM-5 (APA, 2013) proposes nine criteria for IGD.  These include: (1) preoccupation with games; (2) withdrawal symptoms when gaming is taken away; (3) tolerance – the need to spend increasing amounts of time engaged in gaming; (4) unsuccessful attempts to control participation in gaming; (5) loss of interest in previous hobbies and entertainment, as a result of, and with the exception of, gaming; (6) continued excessive use of games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of gaming; (8) use of gaming to escape or relieve a negative mood; and (9) jeopardy or loss of a significant relationship, job, or educational or career opportunity because of participation in games.  When compared with the DSM-5 diagnostic criteria for substance use disorders (addiction), there is significant overlap present between IGD and addiction diagnoses, as outlined below in Table 1.