Pathological gaming and psychiatric symptoms
Certainly, there are valid points in support of and against the creation of a gaming disorder diagnosis, but it is pathological gaming’s impact on our patient population that should prompt attention from the field of psychiatry. While the percentage of total gamers that meets proposed gaming disorder criteria appears quite small, the noted comorbidity between psychiatric diagnoses and pathologic gaming suggests that individuals who meet IGD criteria may be more likely to be our patients.9 As psychiatrists we must recognize this pathological behavior and help address it, just as we would help manage binge eating or cannabis use disorders—whether maladaptive coping skills or stand-alone diagnoses.
Psychiatry’s recognition of the disorder is especially important considering that pathological gaming may have a more negative impact on those with existing psychiatric illness. Among individuals seeking treatment for IGD, those with higher scores on baseline Beck Depression Inventory (BDI) rating scales required extended IGD treatment and individuals who endorse comorbid ADHD symptoms also appear to have more severe IGD.10,11
Thus, while support of a gaming disorder diagnosis might risk stigmatizing or incorrectly assigning pathologic behavior to healthy gamers, it might also help to advance international knowledge of IGD in vulnerable populations with comorbid psychiatric illness. Moreover, WHO’s designation of gaming disorder may also be a necessary first step toward improving research on internet addiction, or problematic internet use (PIU). PIU research is similarly plagued by use of many different diagnostic criteria and screening tools although individuals with PIU alone appear to be in a different demographic than those with gaming disorder, with different comorbidities (eg, individuals with only gaming disorder are more likely to be male).8 PIU similarly appears to pose a unique risk to those with existing psychiatric illness. For example, psychiatrically hospitalized adolescents with PIU are more likely to exhibit both suicidality and aggression than psychiatrically hospitalized adolescents without PIU.12
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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