Problem Gaming: Player One Continue?

Video games may have once been the domain of the stereotypical introverted young male gamer, but today they’ve become one of America’s most popular forms of entertainment. Fifty-nine percent of Americans now play video games.[1] Almost half of them are girls and women – in fact, adult female gamers (36 percent) now substantially outnumber male gamers under 18 (17 percent).[2] Although the age of the average gamer is 31 years old,[3] video games are also popular among older adults, with nearly half of adults over 50 playing games.[4]

Gaming is on the rise among children too. Average daily gameplay in children increased from about a half-hour a day in 1999 to almost two hours a day in 2009.[5] Over 90 percent of kids play video games today, and 25 percent of young males play video games for at least four hours a day.[6]Just like with alcohol consumption, most video game players exercise moderation and play responsibly. But unlike with alcohol, video game use isn’t necessarily a problem as long as the gamer isn’t neglecting their responsibilities, other hobbies, and friends.

Not every gamer can pull off this balance successfully. Some people may experience problems with their video gaming. These problems can interfere with daily life, spiral out of control, and eventually lead to video game addiction.

What Is Video Game Addiction?

Video game addiction is the most severe form of problem gaming. It can resemble other forms of addictive behavior, such as gambling addiction, in that it is characterized by a pattern of intrusive thoughts and compulsive behavior. This can include:

  • Needing to play more and more in order to get the same feeling of reward from the game
  • Feeling angry, irritable, depressed, or frustrated when unable to game
  • Feeling urges or cravings to play video games when not gaming
  • Gaming for longer than planned or intended
  • Experiencing recurring, intrusive thoughts about gaming when not playing
  • Repeated, unsuccessful attempts to cut down on or reduce gaming
  • Feeling unable to step away from a game to deal with chores or tasks
  • Lying to family or friends about the amount of time spent gaming
  • Neglecting responsibilities and obligations, like school, work, or family, in order to play video games

Although gaming addiction is not currently a recognized mental health disorder, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) recommends investigating Internet Gaming Disorder for research and potential inclusion in future editions.[7] Using criteria similar to those used to diagnose gambling addiction (like those listed above), one study found that about eight percent of children ages eight to 18 experienced pathological video gaming.[8] A meta-analysis found that using these criteria may artificially inflate the rates of diagnosis, and that the number is likely closer to three percent among youth and young adults.[9]

In a few rare, extreme cases, gaming addiction can make people dangerous to others.

  • In 2005, Shanghai gamer Qiu Chengwei lent his friend Zhu Caoyuan a virtual sword in the game Legend of Mir 3. Zhu had sold the sword online for 7,200 yuan (roughly $870 in 2005). When Qiu found out, he stabbed Zhu in the chest and killed him. Qiu was given a suspended death sentence, which will likely result in life in prison.[10]
  • In 2006, New Mexico resident Rebecca Colleen Christie grew obsessed with the game World of Warcraft, playing for up 15 hours a day. She neglected her 3-year-old daughter Brandi Wulf, who finally died of starvation. Christie was sentence to 25 years in prison.[11]
  • In 2007, Ohio teenager Daniel Petric shot his parents – killing his mother – after they took away his copy of Halo 3. According to the judge, his gaming addiction had grown so severe that he had lost touch with reality, forgetting that, unlike in the game, death is permanent. He received 23 years in prison.[12]
  • In 2010, two South Korean parents spent hours a day playing Prius Online in an internet café, leaving their 3-month-old daughter Sarang at home. She died of malnourishment. Although initially charged with murder, they were ultimately convicted of involuntary manslaughter, because the judge concluded that their gaming addiction prevented them from fully understanding their actions.[13]
  • In 2014, an unemployed 22-year-old South Korean man, whose surname is Chung, ignored his 2-year-old son to play video games at an internet café. He only returned home approximately once every three days to feed the baby, who eventually died of starvation.[14]

In South Korea, where games like Starcraft are played professionally in stadiums before thousands of spectators, somewhere between two percent[15] and 30 percent[16] of South Korean children might show signs of video game addiction. Legislators are taking steps to combat gaming addiction: South Korea’s Ministry of Culture, Sports and Tourism put into place a “gaming curfew” that restricts gaming for six hours in the middle of the night.[17] The ban applied to about 19 games, including Maple Story.

South Korea also treats video game addiction as grounds to exempt someone from military service[18] and is debating legislation to regulate video gaming like drugs, alcohol, and gambling.[19]

Addictive by Design

Many games are engineered to deliberately exploit the reward mechanisms of human behavior that maximize the user returning for more.[20] The basic model is simple: the more you play, the more rewards you get, such as gaining achievements, unlocking content, or leveling up. Game designers can tweak the rate of rewards to be variable, so that there’s an element of chance – killing a monster in Diablo, for example, might or might not drop a powerful sword. By adjusting the probabilities and using similar principles as those that drive gambling, designers can maximize the rate at which gamers will keep playing, hoping for another reward.

Another tactic is to introduce the perception of loss. For example, in games like Farmville, once your crops ripen, you must harvest them within a certain time window or you will lose the crop to rot, drawing you back to the game. In another game, you might receive five “lives” each day, and if you don’t play each day, you lose those lives. Some games introduce gambling outright with bonuses like a daily spin, which give you a chance at winning extra gold, lives, items, or other rewards. The problem becomes even more insidious when compounded with pay-to-play models – for example, in the game RuneScape you can spend real-world money to buy keys that unlock chests with only a chance at containing rare items.

Social games add yet another layer of pressure to keep playing. Many games are organized into teams, clans, or guilds where players band together to accomplish more difficult tasks. In World of Warcraft, you might have commitments to your guild to participate in a certain number of raids every week, each of which can take hours to complete. In Candy Crush Saga, you can ask your friends to send you extra lives, drawing them back into the game as well.

All of these game design factors combine together to make games attractive and to draw you back for more. It’s a compelling business model, but for many individuals, it encourages patterns that can be unhealthy.

What Is Problem Video Gaming?

You don’t have to be addicted to video gaming in order to experience trouble because of gaming. Problem video gaming is, quite simply, gaming to an extent that it creates disturbances in your life, whether they be at school, work, or home. Here are some warning signs that you or your child might have problems with gaming:

  • Spending hours at the computer/console without breaks
  • Gaming at night and sleeping during the day, losing sleep because of gaming, or falling asleep at work or in school
  • Poor performance at work or school because of gaming
  • Skipping meals or neglecting hygiene in order to keep gaming
  • Skipping social activities with family and friends in order to game
  • Loss of interest in previously enjoyed hobbies
  • Spending irresponsible amounts of money on in-game content
  • Feeling guilty when unable to meet in-game social obligations, like guild quests
  • Losing track of how much time has been spent in a given gaming session
  • Experiencing headaches, neck aches, dry eyes, aching thumbs, or aching wrists from gaming

Who Is at Risk for Problem Video Gaming?

A number of factors can influence who is vulnerable to problem video gaming:

  • Adolescence,[21] particularly among males,[22] places gamers at higher risk for developing a video game addiction. In the developing teenage brain, the centers that are responsible for impulse control and sound judgment haven’t yet developed properly. The development process takes longer in males, leaving them at-risk for a greater period of time.
  • Attention deficit hyperactivity disorder (ADHD)[23] and autism[24] both interact with the psychological mechanisms of addiction. People with ADHD are vulnerable to the dopamine-releasing reward structures of some games, and people with autism may be prone to fixation.
  • Mental illness and stress can fuel escapism as people try to avoid their problems in life by immersing themselves in role-playing games. One study found that 41 percent of online gamers played to escape.[25]
    “Pathological game use may be a symptom of other underlying problems (e.g., depression, social phobia) that may be more difficult to treat—if someone is using video games to escape these problems, then abstention from video games might only treat those symptoms of video game use while leaving the underlying problem intact.” -Joseph Hilgard, Christopher R. Engelhardt, and Bruce D. Bartholow, University of Missouri-Columbia.[26]
  • Poor social integration increases the likelihood of obsessive online gaming. People who feel like they need the approval of their peer group, or who game in order to gain social status in the game, are more likely to have problems with gaming.[27] Among children, poor social integration into their class also predicts problem gaming.[28]

Video Games, the Body, and the Brain

Excessive video game use can lead to a number of physiological problems in the body. Sitting for long periods of time, which can occur with non-active games, increases the risk of heart disease.[29] The repetitive motions of many games can also strain the wrists and hands, causing repetitive stress injuries. People who spend long periods of time video gaming may also exercise less as a result.

Spending too long staring at a screen, especially late at night, can throw off your body’s internal clock. The brightness of the screen impairs the brain’s production of melatonin, a hormone needed for timely and restful sleep.[30]

Too much gaming can also directly affect the brain itself. Effects on the brain can include:

  • Overdevelopment and hyperactivity of the striatum, a region of the brain associated with reward, gambling, and addiction[31]
  • Abnormal white matter, which forms the connections between different brain regions, in a pattern consistent with drug addiction[32]
  • Deterioration of grey matter, which forms the processing centers of the brain, in areas related to planning, organizing, and self-control[33]

As a Parent, How Can I Get Involved?

If you have a child who enjoys video games, here are steps you can take to make sure he or she doesn’t develop problems with gaming:

  • Help your child find other friends and activities. Boredom can produce a powerful drive to play video games. Finding other hobbies and social groups will help reduce the urge to spend as much time gaming.
  • Be informed. Keep an eye on how much time your child is spending playing video games and at what hours. Learn about each game your child plays to ensure its content is appropriate.
  • Pay attention. If your child’s sleep, eating, or hygiene patterns change for the worse, or if you see a decline in schoolwork, chores, or other activities, it may be time to intervene.
  • TalkIf your child suddenly starts spending a lot more time playing video games, there may be a bigger problem going on. Be patient and prepared to initiate a conversation about what might be wrong.
  • Set limits. Decide how much time your child is permitted to play video games, and be firm in enforcing that number. Eighty-three percent of parents limit the amount of time they let their children play video games.[34] The American Academy of Pediatrics suggests that families restrict their children’s entertainment media consumption to one or two hours per day.[35]

Getting the Help You Need

Are you, or is a loved one, struggling with video game addiction? If so, there may be an underlying mental health issue that drives the behavior; if this occurs in combination with substance abuse, it is called a dual diagnosis. Treating just the addiction leaves you vulnerable to relapse, as you may still feel the urge to self-medicate your mental illness. Dual diagnosis specialty clinics will be able to treat both the illness and the addiction as primary disorders. By treating both conditions at the same time, you give yourself the best possible chance of making a full recovery.

Video game addiction is not yet formally recognized, so there aren’t a lot of studies on what works to treat it. However, promising treatments include:

  • Cognitive Behavioral Therapy, which can help correct compulsive behavior
  • Family therapy, which can help rebuild damaged family relationships that might be contributing to excessive gaming
  • Residential therapy, which provides an option for those who need to spend time on site away from game technology to focus on building new, healthy behaviors

Call to learn more about how we can help you step away from video gaming and closer to a more balanced life.


[1] “2014 Sales, Demographic, and Usage Data: Essential Facts About the Computer and Video Game Industry.” (2014). The Entertainment Software Association. Accessed September 11, 2014.

[2] Ibid.

[3] Ibid.

[4] “Gamers Over 50: You’re Never Too Old to Play.” (n/a). The Entertainment Software Association. Accessed September 11, 2014.

[5] Anderson, C. and Gentile, D. (March 5, 2014). “Violent video game effects on aggressive thoughts, feelings, physiology, and behavior.” Media violence and children. Westport, CT: Praeger. Accessed September 11, 2014.

[6] Prot, S., McDonald, K.A., Anderson, C.A., and Gentile, D.A. (June 2012). “Video Games: Good, Bad, or Other?” Pediatric Clinics of North America. Accessed September 11, 2014.

[7] “Internet Gaming Disorder.” (May 2013). Accessed September 11, 2014.

[8] Gentile, D. (2009). “Pathological Video-Game Use Among Youth Ages 8 to 18.” Psychological Science. Accessed September 11, 2014.

[9] Ferguson, C.J., Coulson, M., and Barnett, J. (December 2011). “A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems.” Journal of Psychiatric Research. Accessed September 11, 2014.

[10] “Chinese gamer sentenced to life.” (June 8, 2005). BBC News. Accessed September 11, 2014.

[11] Associated Press. (June 3, 2011). “New Mexico mom gets 25 years for starving daughter.” Fox News. Accessed September 11, 2014.

[12] Associated Press. (June 16, 2009). “Teen who killed over video game gets 23 years.” NBC News. Accessed September 11, 2014.

[13] Newman, L.H. (July 29, 2014). “Can a Baby’s Death Tell Us Anything About Video Game Addiction?” Slate. Accessed September 11, 2014.

[14] Moran, Lee. (April 16, 2014). “Video-game addicted South Korean dad let 2-year-old son starve to death: cops.” New York Daily News. Accessed September 11, 2014.

[15] Associated Press. (December 11, 2013). “South Korea: Are video gamers as bad as drug addicts?” New York Post. Accessed September 11, 2014.

[16] Bosker, B. (June 10, 2010). “South Korea Imposes Midnight Gaming Ban To Combat Addiction.” Huffington Post. Accessed September 11, 2014.

[17] Ibid.

[18] “South Korea’s video game addicts may be exempt from military service.” (July 21, 2014). Fox News. Accessed September 11, 2014.

[19] Hwang, Sa Youn. (June 23, 2014). “South Korea’s Game Addiction Law could treat games like drugs and alcohol.” CNET. Accessed September 11, 2014.

[20] Hilgard, J., Engelhardt, C.R., and Batholow, B.D. (September 9, 2013). “Individual differences in motives, preferences, and pathology in video games: the gaming attitudes, motives, and experiences scales (GAMES).” Frontiers in Psychology. Accessed September 11, 2014.

[21] Vitelli, R. (August 19, 2013). “Are Video Games Addictive?” Psychology Today. Accessed September 11, 2014.

[22] Rehbein, F., and Baiser, D. (2013). “Family-, media-, and school-related risk factors of video game addiction: A 5-year longitudinal study.” Journal of Media Psychology: Theories, Methods, and Applications. Accessed September 11, 2014.

[23] Bioulac, S., Arfi, L., and Bouvard, M.P. (March 2008). “Attention deficit/hyperactivity disorder and video games: A comparative study of hyperactive and control children.” European Psychiatry. Accessed September 11, 2014.

[24] Severson, A. (April 19, 2013). “Children with Autism More Likely to Develop Video Game Addiction.” Healthline. Accessed September 11, 2014.

[25] Hussain, Z., and Griffiths, M.D. (February 20, 2009). “Excessive Use of Massively Multi-Player Online Role-Playing Games: A Pilot Study.” International Journal of Mental Health and Addiction. Accessed September 11, 2014.

[26] Hilgard, J., Engelhardt, C.R., and Batholow, B.D. (September 9, 2013). “Individual differences in motives, preferences, and pathology in video games: the gaming attitudes, motives, and experiences scales (GAMES).”

[27] Ibid.

[28] Rehbein, F., and Baiser, D. (2013). “Family-, media-, and school-related risk factors of video game addiction: A 5-year longitudinal study.” Journal of Media Psychology: Theories, Methods, and Applications. Accessed September 11, 2014.

[29] Katzmarzyk, P.T., Church, T.S., Craig, C.L., and Bouchard, C. (May 2009). “Sitting time and mortality from all causes, cardiovascular disease, and cancer.” Medicine & Sports in Sports & Exercise. Accessed September 11, 2014.

[30] Dunckley, V. (March 12, 2011). “Wired and Tired: Electronics and Sleep Disturbance in Children.” Psychology Today. Accessed September 11, 2014.

[31] Kühn, S., Romanowski, A., Schilling, C., Lorenz, R., Mörsen,C., Seiferth, N., Banaschewski, T., BarbotA., Barker, G.J., Büchel, C., Conrodc P.J., Dalley, J.W., Flor, H., Garavan, H., Ittermann, B., Mann, K., Martinot, J-L., Paus, T., Rietschel, M., Smolka, M.N., Ströhle, A., Walaszek, B., Schumann, G., Heinz, A., and GallinatJ. (November 15, 2011). “The neural basis of video gaming.” Translational Psychiatry. Accessed September 11, 2014.

[32] Lin, F., Zhou, Y., Du, Y., Qin, L., Zhao, Z., Xu, J., and Lei, H. (January 11, 2012). “Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study.” PLOS One. Accessed September 11, 2014.

[33] Dunckley, V.L. (February 27, 2014). “Gray Matters: Too Much Screen Time Damages the Brain.” Psychology Today. Accessed September 11, 2014.

[34] “2014 Sales, Demographic, and Usage Data: Essential Facts About the Computer and Video Game Industry.” (2014). The Entertainment Software Association. Accessed September 11, 2014.

[35] “Media and Children.” (n/a) American Academy of Pediatrics. Accessed September 11, 2014.

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