Internet Gaming Disorder DSM-5

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DSM-5 Category: Conditions for Further Study

Introduction

Internet Gaming Disorder, or IGD, is the excessive use of computers or other devices that provide the user access to the Internet, for example tablets, and smartphones, for online activities to the extent that they profoundly compromise daily life activities and responsibilities. In 2013, the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) included IGD in Section III—Conditions Warranting More Experience and Research before it might gain recognition officially (APA, 2013). Young and Nabuco de Abreu (2011) prefer the term Internet Use Disorder, or IUD, because it more closely encompasses the countless Internet activities available rather than simply gaming. Due to the expansive online venues available using the Internet, some experts argue to change the name of the disorder, for example, "Excessive Web Use" or another name that is more inclusive of the myriad ways possible to use the Internet excessively (Wolchover, 2012). Time will tell if the disorder is ever recognized officially, and by what name, although “Internet Use Disorder” covers a much broader spectrum than gaming.

Mechanism of Internet and Gaming Addiction

Hepburn (2013) contemplates what life is like in the age of Internet addiction. Researchers are attempting to identify the single variable that irrefragably connects internet addiction with all other forms of addiction accepted as official disorders by the profession. That variable is believed to be excessive release of dopamine. Dopamine is a neurotransmitter occurring in the brain that regulates pleasure. Various Internet activities, such as gaming and social media, provide intermittent brain-chemical reinforcement.

When a task is below an individual's skill or reasoning ability, that person quickly learns to anticipate future outcomes and becomes bored with the task. The “rewards” come too easily and were therefore unrewarding. Contrasting this scenario, imagine the same person exploring Internet activity that is far more advanced than that person's skill level and reasoning ability. This would cause the individual to become frustrated. In the second situation, the person never receives a reward because the required skills and understanding are too advanced. However, if an individual selects an activity that rewards just frequently enough, that person's brain will continuously release dopamine. The person associates pleasure with the activity and continues playing indefinitely.

Currently, with the lack of extant data on Internet Addiction, the dispute will continue between those who view it as an example of depression or pathological gambling or if it warrants a new classification as a unique mental health disorder (Wallace, 2014)

Symptoms of Internet Gaming Disorder

According to the DSM-5, there is insufficient research on IGD to establish diagnostic criteria and prevalence, therefore it strongly encourages purposeful investigations on IGD. In 2014, Wallace identified the following symptoms associated with IGD:

  • Overwhelming preoccupation with online-activities to an extent, that leads to impairment or distress
  • Inability to limit time spent on the Internet
  • Loss of other interests
  • The need to spend increasing time on the Internet
  • Unsuccessful attempt to quit Internet-use
  • Use of the Internet to improve or escape aversive conditions, for example stress, Unfavorable duties, dysphoric mood
  • Withdrawal symptoms when the Internet is no longer available.

In addition, Wallace discusses several subtypes of IGD including inappropriate pornography use, overwhelming, Online-gaming, Internet-shopping, online social networking, or blogging. Some of these to be symptoms of other mental health problems. Wallace, 2014, offers two examples, 1) that excessive Internet-shopping might be a symptom of a depressive disorder and 2) extreme social networking can be an avoidance-behavior among individuals suffering from social anxiety disorder.

Onset of Internet Gaming Disorder (IGD)

Reporting on IGD among adolescents and its relationship to chronotype of personality, Vollmer, Randler, Horzum, and Ayas (2014) state that gender and age are important factors in developing computer game addiction (CGA). Studies indicate that boys and men were more prone to addiction to games and spent more time playing on computers than girls and women. According to the DSM-5 there is a negative relationship between age and IGD. Highest usage reported occurs among boys between the ages of 11- and 17-year-olds. This group tends to spend more time playing than do younger boys or older adults. Personality traits common among IGD sufferers are higher neuroticism and openness scores. In contrast, internet addiction sufferers tend to score low on extraversion and agreeableness measures.

Comorbidity of IGD

In 2014, Wallace reported that the profession knows very little about the comorbidity of IGD. There are studies showing high comorbidity with social anxiety, attention deficit hyperactivity disorder (ADHD), affective disorders, depression, and substance use disorder, however most of the previous studies have many methodological limitations.

Treatment For Internet Gaming Disorder

According to the DSM-5, despite IGD receiving extensive media coverage, there are few randomized trials on the treatment of IGD using a double-blind model. Most of the research on IGD to date used inconsistent criteria to define IGD or lacked a highly robust methodological quality in assessing the therapeutic outcome. That said, Wallace, in 2014, discussed cognitive behavior therapy (CBT) and self-help programs having effective outcomes on persons with IGD. Along with this, family counseling and psychological education therapies might also be helpful treatment approaches. Currently, there is a paucity of data on the pharmacotherapy efficacy on IGD. However, the following approved medications are recommended: antidepressants, anxiolytics, mood stabilizers, and Naltrexone.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Hepburn, N. (2013, January 24). Life in the age of internet addiction. The Week. Retrieved from http://theweek.com/article/index/239243/life-in-the-age of-internet-addiction

von Deneen, K. M., & Tian, J. (2013). Five new mental disorders you could have under DSM-5. Retrieved from https://theconversation.com/five-new-mental-disorders-you-could-have under-dsm-5-14192

Wallace, P. (2014). Internet addition disorder and youth. EMBO reports, 15: 12-16. doi: 10. 1002/embr.201338222

Walton, A. G. (2012). Internet addiction: The new mental health disorder? Retrieved from http://www.forbes.com/sites/alicegwalton/2012/10/02/the-new-mental-health-disorder-internet addiction/

Vollmer, C., Randler, C., Horzum, M. B., & Ayas, T. (2014, January 10). Computer game addiction in adolescents and its relationship to chronotype and personality. Sage doi: 10.1177/2158244013518054. Retrieved from http://sgo.sagepub.com/content/4/1/2158244013518054

Wolchover, N. (2012). What is Internet Use Disorder? Retrieved from http://news.yahoo.com/internet-disorder-212614333.html

Young, K., & Nabuco de Abreu, C. (2011). Internet Addition – A handbook and guide to evaluation and treatment. John Wiley & Sons, Inc., Hoboken, NJ.


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