‘Gaming disorder’ named a mental health condition

NORWALK — Garrett Longenecker visits Game Stop on Connecticut Avenue once or twice a month for new games and devices.

A self-proclaimed gamer, Longenecker spends at least four or five hours after work playing sports and role-playing games online or on consoles with friends who are no longer in the area. While he spends a significant part of his day gaming, he said it’s never come to the point of interfering with his life.

So he was surprised to hear the World Health Organization added “gaming disorder” to its list of addictive disorders last week.

The 11th revision of the International Classification of Diseases defines gaming disorder as being characterized by “a pattern of persistent or recurrent gaming behavior” that can be online or offline, manifested by impaired control over gaming, increasing priority given to gaming and continuation of gaming despite the occurrence of negative consequences.

“It’s a little bit ridiculous,” Longenecker said. “I probably put in a thousand hours in my life. But it’s a personal choice.”

The decision to add gaming disorder to the ICD-11 has also received criticism from experts who say that the research and the methodology surrounding gaming disorder aren’t 100 percent conclusive and that the disorder itself could be masquerading the main mental health issue at hand.

While David Greenfield thinks such points are valid, he ultimately believes it is erroneous to claim that gaming can’t be an addiction and therefore a mental health condition.

He said he’s been treating and diagnosing gaming disorder since the late 1990s, when he founded the Center for Internet and Technology Addiction based in West Hartford. Since then, he’s seen the number of patients increase tenfold and is now treating 400 to 500 patients year-round — from teenagers to adults in their mid- to late 20s.

Part of this increase may be because his center is one of few in the nation, he noted. But he also feels it has to do with growing awareness of the disorder and the availability of treatments.

“Most people game just fine without any problem. We’re talking about a very select number of people who have more significant problems,” said Greenfield, also an assistant clinical professor of psychiatry at the University of Connecticut School of Medicine. “In other words, you don’t diagnose if everything is working just fine — they’re working, their family relationships are normal, and legal, financial, medical issues are fine.”

Greenfield follows the criteria for internet gaming disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association. The disorder was added in 2013 and was largely based on gambling disorder, Greenfield noted. He pointed out that the addictive quality in some games is the same reinforcement schedule that a slot machine follows.

“It’s a variable ratio reinforcement, meaning it’s unpredictable when you’re going to get a reward and how good that reward is going to be,” he explained.

Prevalence statistics show that 1 percent of more than 150 million gamers have the disorder, Greenfield said, while other statistics say it’s as high as 6 to 8 percent. Regardless, the number of those affected by the disorder is still significant, which is why he believes adding gaming disorder to the WHO’s International Classification of Diseases is a major step forward since it will allow for greater accessibility to treatment and facilitation of more research.

“We didn’t create this disorder. The disorder showed up at our door,” Greenfield said. “We didn’t even advertise in the beginning. People just found out and they said, ‘We need help,’ and we helped them.”

Nadja Streiter, a clinical worker and therapist at the center, said patients struggling with gaming disorder or gaming in general often have other diagnoses such as ADHD, anxiety and/or depression, as well as a lack of social skills. She sees the latter as being a real challenge for patients she currently helps.

“A lot of these kids become involved in gaming because they are socially isolated ... So they turn to gaming. It’s entertaining. It’s accessible,” said Streiter, of Westport. “It gives them the opportunity to have friends, and that feels good. But the qualities of the game itself are very addictive.”

Marc Portenza, the director of the Yale Center of Excellence in Gambling Research, said he’s had his concerns about the addictive quality of gaming since the early 2000s, both as a researcher and a psychiatrist.

Also a professor of psychiatry, neuroscience and child study at the Yale University School of Medicine, Portenza surveyed about 4,000 Connecticut youths on gaming behavior about a decade ago. More recently, he’s been involved in collaboration with groups in Asia to understand how the brain of a person with a problematic internet or video-gaming disorder differs from a person without it.

“I think we do need to be mindful that gaming, like gambling is a prevalent behavior and many people do not encounter mental health concerns related to their gaming,” Portenza said. “But for the people who do, we should be able to have a means to identify, diagnose, and treat those individuals.”