Limited treatment options
Another potential barrier to recognizing “gaming disorder” is that there are limited treatment options for the disorder. There is a long-standing adage in medicine that once a physician officially recognizes and documents a problem, the onus is then on the physician to figure out how to fix it. For gaming disorder, the lack of standardized research makes treatment decisions exceedingly challenging.
What little evidence there is suggests that treatment options similar to those used in addictive disorders (eg, bupropion, cognitive behavioral therapy) may provide some benefit, and that treating comorbid conditions (eg, ADHD, depression) may be helpful.7 However, in order to discern effective treatment options for IGD, a standardized definition, diagnosis, and screening method are crucial; therefore, without international recognition of IGD and subsequent standardization of diagnostic criteria and screening, treatment studies will likely continue to be inadequate.
Pathological gaming as a stand-alone diagnosis
Perhaps the most significant debate over the existence of IGD relates to the question of whether pathological gaming and internet use are associated phenomena resulting from mental health disorders, rather than separate entities. IGD has been found to be comorbid with numerous psychiatric diagnoses, including depression and anxiety. A 2016 study found low intercorrelation between addictive online variables and evidence that psychiatric diagnoses contributed significantly to any noted variance between addictive internet and gaming behaviors.8
Regardless of these findings, there are few diagnoses that exist in true isolation in psychiatry, and even if pathological gaming is the result of a preexisting psychiatric disorder, a teenager who begins engaging in excessive alcohol use to cope with MDD will often get both a diagnosis of alcohol use disorder and MDD. If another teenager begins engaging in pathological gaming as a coping mechanism for managing the same depressive symptoms, it is worth questioning why giving the dual diagnoses of MDD and the addictive disorder would be appropriate in the former, but not the latter.
Dr Gansner is Instructor in Psychiatry, Cambridge Health Alliance, Cambridge, MA. She reports no conflicts of interest concerning the subject matter of this article.
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