Category Archives: Addiction
Reliable statistics on the prevalence of individuals addicted to work on a country-by-country basis are almost non-existent. Only two countries (Norway and Hungary) has carried out nationally representative studies. Norwegian studies led by Dr. Cecilie Andreassen reported that approximately 7.3%-8.3% of Norwegians are addicted to work using the Bergen Work Addiction Scale. A Hungarian study led by Dr. Zsolt Demetrovics reported that 8.2% of the 18- to 64-year old population working at least 40 hours a week is at risk for work addiction using the Work Addiction Risk Test.
In a comprehensive literature review that I co-authored using US data, provided a tentative estimation of the prevalence of work addiction among Americans at 10%. Some estimates are as high as 15%-25% among employed individuals although some of these estimates appear to relate to excessive and committed working rather than a genuine addictive behaviour Others claim that the rates of work addiction are high amongst professionals (e.g., lawyers, medics, scientists). Such individuals may work very long hours, expend high effort in their job, delegate rarely, and may not necessarily be more productive. It also appears that those genuinely addicted to work appear to have a compulsive drive to gain approval and success but can result in impaired judgment, poor health, burnout, and breakdowns as opposed to what might be described ‘enthusiastic workaholism’ where few problems are associated with the behaviour.
Last month, I and two of my colleagues published a paper in the Journal of Behavioral Addictions examining various myths concerning work addiction. One of the myths we explored was that ‘work addiction is similar to other behavioural addictions’. While work addiction does indeed have many similarities to other behavioural addictions (e.g., gambling, gaming, shopping, sex, etc.), it fundamentally differs from them in a critical way because it is the only behaviour that individuals are typically required to do eight hours a day and is an activity that individuals receive gratification from the local environment and/or society more generally for engaging in the activity. There may also be some benefits from normal [and excessive] work (e.g., financial security through earning a good salary, financial bonuses based on productivity, international travel, free or reduced medical insurance, company car, etc.). Unlike other behavioural and substance addictions where one of the key criteria is typically a negative impact on occupational duties, work addicts cannot negatively impact on the activity they are already engaged in (except in the sense that their addiction to work may impacts on work productivity or work quality due to resulting psychological and/or physical illness).
In some respects, work addiction is similar to exercise addiction in that it is an activity that should be a part of people’s lives and often has some benefits even when engaged in excessively. Such activities have been described by Ian Brown as ‘mixed blessings’ addictions. For instance, in the case of exercise addiction, problematic exercise that interferes with both job and relationships can still have some positive consequences (such as being physically fit). However, it should be emphasized that such positive consequences are typically short lasting, and in the long run, addiction will take its toll on health (even exercise in excess is physiologically unhealthy in the long run in terms of immune function, cardiovascular health, bone health, and mental health). Furthermore, some research suggests that work and exercise addiction have also similar personality correlates different from other addictions, namely high conscientiousness. This might contribute to the fact that work addiction is so perplexing because this personality trait is consistently linked to better health.
Another myth we explored was ‘work addiction and workaholism are the same thing’. The issue of whether ‘workaholism’ and ‘work addiction’ are the same entity depends on how these constructs are defined. For instance, I have argued that any behaviour that fulfils six core components (i.e., salience, conflict, mood modification, tolerance, withdrawal symptoms, and relapse) should be operationalized as an addiction. These six components have also been the basis of many psychometric instruments for assessing potential addictions including work addiction (such as the Bergen Work Addiction Scale that I co-developed and was published in a 2012 issue of the Journal of Scandinavian Psychology). The empirical research carried out by myself and others over the last five years concerning ‘work addiction’ is theoretically rooted in the core addiction literature whereas ‘workaholism’ncludes a wider range of theoretical underpinnings and in some research is a construct seen as something positive rather than negative. Arguably, in popular press and in common everyday language ‘workaholism’ is often used as a positive notiono describe very engaged workers, which adds significantly to the confusion about the two terms.
‘Workaholism’ is arguably a generic term that throughout the literature (as well as by lay people and the popular press) appears to equate to excessive working irrespective of whether the consequences are advantageous or disadvantageous. There is clearly lack of precise dictionary definitions of ‘work addiction’ and ‘workaholism’, and there is no reason to assume they could not be used as synonyms. However, the common use of the term ‘workaholism’ to denote anything related to high involvement in work may suggest that for practical reasons in the professional literature on work addiction, understood within addiction framework, it would be advisable to limit usage of this term. While, it is almost impossible to control natural usage of terms, preference for ‘work addiction’ in addiction literature would be a way to emphasize the addiction framework in which the phenomenon is being conceptualized. In short, ‘work addiction’ is a psychological construct while ‘workaholism’ is arguably a more generic term.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of norwegian employees. PLoS ONE, 9, e102446. doi:10.1371/journal.pone.0102446
Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265–272. doi:10.1111/sjop.2012.53.issue-3
Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016) The Relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11: e0152978. doi:10.1371/journal.pone.0152978
Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R. Eadington & J. Cornelius (Eds.), Gambling Behavior and Problem Gambling (pp. 341-372). Reno, Nevada: University of Nevada Press.
Griffiths, M. D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.
Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.
Griffiths, M. D. (2005b). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191–197
Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.
Griffiths, M.D., Demetrovics, Z. & Atroszko, P.A. (2018). Ten myths about work addiction. Journal of Behavioral Addictions. Epu ahead of print. doi: 10.1556/2006.7.2018.05
Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.
Paksi, B., Rózsa, S., Kun, B., Arnold, P., Demetrovics, Z. (2009). Addictive behaviors in Hungary: The methodology and sample description of the National Survey on Addiction Problems in Hungary (NSAPH). [in Hungarian] Mentálhigiéné és Pszichoszomatika, 10(4), 273-300.
Quinones, C., & Griffiths, M. D. (2015). Addiction to work: A critical review of the workaholism construct and recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48–59.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
In previous blogs I have looked at the alleged addictiveness of extreme sports including BASE jumping and bungee jumping as well as briefly overviewing so called ‘adrenaline junkies’. Over the last year, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving.
In the first paper on withdrawal symptoms published last year in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports. For instance, they noted:
Extreme sports athletes commonly describe a “rush” or “high” when participating in their sport (Buckley, 2012; Price & Bundesen, 2005) and liken these experiences to those of drug users (Willig, 2008). For example, a participant in Willig’ s study described: “It’s like for a drug user, they will take cocaine to get high. For me it’s my addiction, I have to go to the mountains to get high.” Similarly, skydivers have described their sport as “like an addiction,” stating that they “can’t get enough,” and their “relationships suffer” as a result (Celsi, Rose, & Leigh, 1993).”
They also noted prior research suggesting that athletes may experience withdrawal states during periods of abstinence that are also characteristic of those with an addiction. Heirene and his colleagues claimed that this their study was the first to explore withdrawal experiences of individuals engaged in extreme sports. They carried out a study very similar to one of my own where Michael Smeaton and I published a study where gamblers were specifically interviewed about their experiences of withdrawal (in a 2002 issue of Social Psychological Review).
Heirene’s team used semi-structured interviews to explore withdrawal experiences of what they defined as ‘high ability’ and ‘average-ability’ male rock climbers during periods of abstinence (four climbers in each of the two groups). They then investigated the behavioural and psychological and aspects of withdrawal (including craving, anhedonia [i.e., the inability to feel pleasure in normally pleasurable activities], and negative affect) and examined the differences in the frequency and intensity of these states between the two rock climbing groups. Based on an analysis of the interview transcripts, they found support for the existence of anhedonia, craving, and negative affect among rock climbers. They also reported that the effects were more pronounced and intense among the high ability rock climbers (apart from anhedonic symptoms). The authors also noted:
“All participants reported negative affective experiences during abstinence, including states of “restlessness” and being “miserable,” “agitated,” or “frustrated.” Similar dysphoric states have been identified in drug users, exercise addicts, and extreme sports athletes during abstinence…In the present study, both groups reported using climbing to alleviate negative affective states, particularly stress. This finding supports previous research that has reported skydivers use their sport in a self-medicating manner (Price & Bundesen, 2005). Similarly, psychopharmacology literature has found individuals engage in substance abuse as a means of coping with stress…suggesting similar participation motives in both drug use and extreme sports”.
The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioral addictions. In a second investigation just published in Frontiers in Psychology, the same team (this time led by Gareth Roderique-Davies) reported the development of the Rock Climbing Craving Questionnaire (RCCQ). The development of this new psychometric instrument directly followed on from the previous study which had found evidence of craving amongst the rock climbers that had been interviewed.
In the second paper, the research team attempted to “quantitatively measure the craving experienced by participants of any extreme sports”. They claimed that the RCCQ could allow “a greater understanding of the craving experienced by extreme sports athletes and a comparison of these across sports (e.g., surfing) and activities (e.g., drug-use)”. To develop the RCCQ, they utilized previously validated craving measures as a template for the new instrument to assess craving in the sports of rock-climbing and mountaineering.
The second paper comprised two studies. The first study investigated the factor structure of the craving measure among 407 climbers who completed the RCCQ. (One of the limitations of the study was that the participant sample was heterogeneous and included climbers and mountaineers from multiple primary climbing disciplines, including indoor climbing, outdoor traditional climbing, alpine climbing, and ice climbing). Despite the heterogeneity of the sample, the results demonstrated that a three-factor model explained just over half the total variance in item scores. The three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’) each comprised five items. The second study validated the 15-item RCCQ on 254 climbers using confirmatory factor analysis across two conditions (a ‘climbing-related cue’ condition or a ‘cue-neutral’ condition). The authors concluded that:
“[The first study supported] the multi-dimensional nature of rock climbing craving and shows parallels with substance-related craving in reflecting intention and positive (desire) and negative (withdrawal) reinforcement. [The second study confirmed] this factor structure and gives initial validation to the measure with evidence that these factors are sensitive to cue exposure…if as shown here, craving for climbing (and potentially other extreme sports) is similar to that experienced by drug-users and addicts, there is the potential that climbing and other extreme sports could be used as a replacement therapy for drug users”.
This latter suggestion has been made in the literature dating back to the 1970s and the work of Dr. Bill Glasser on ‘positive addictions’ as well as by psychologists such as Iain Brown who suggested in the early 1990s that gambling addicts should replace their addictions with sensation-seeking activities such as sky-diving and parachuting. Critics will claim that these papers are another example of ‘over-pathologizing’ everyday behaviours, but as I have always argued, if any behaviour fulfils all the core criteria for addiction, they should be operationalised as such.
Dr. Mark Griffiths, Professor of behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Brymer, E., & Schweitzer, R. (2013). Extreme sports are good for your health: a phenomenological understanding of fear and anxiety in extreme sport. Journal of health psychology, 18(4), 477-487.
Buckley, R. (2012). Rush as a key motivation in skilled adventure tourism: Resolving the risk recreation paradox. Tourism Management, 33, 961–970.
Castanier, C., Le Scanff, C., & Woodman, T. (2010). Who takes risks in high-risk sports? A typological personality approach. Research Quarterly for Exercise and Sport, 81, 478–484.
Celsi, R. L., Rose, R. L., & Leigh, T. W. (1993). An exploration of high risk leisure consumption through skydiving. Journal of Consumer Research, 20(1), 1–23.
Glasser, W. (1976). Positive Addictions. New York: Harper & Row.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. & Smeaton, M. (2002). Withdrawal in pathological gamblers: A small qualitative study. Social Psychology Review, 4, 4-13.
Heirene, R. M., Shearer, D., Roderique-Davies, G., & Mellalieu, S. D. (2016). Addiction in extreme sports: An exploration of withdrawal states in rock climbers. Journal of Behavioral Addictions, 5(2), 332-341.
Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.
Monasterio, E., & Mei-Dan, O. (2008). Risk and severity of injury in a population of BASE jumpers. New Zealand Medical Journal, 121, 70–75.
Monasterio, E., Mulder, R., Frampton, C., & Mei-Dan, O. (2012). Personality characteristics of BASE jumpers. Journal of Applied Sport Psychology, 24, 391-400.
Price, I. R., & Bundesen, C. (2005). Emotional changes in skydivers in relation to experience. Personality and Individual Differences, 38, 1203–1211.
Roderique-Davies, G. R. D., Heirene, R. M., Mellalieu, S., & Shearer, D. A. (2018). Development and initial validation of a rock climbing craving questionnaire (RCCQ). Frontiers in Psychology, 9, 204. doi: 10.3389/fpsyg.2018.00204
Willig, C. (2008). A phenomenological investigation of the experience of taking part in extreme sports. Journal of Health Psychology, 13(5), 690-702.
As a teenager I was fascinated with LSD purely as a consequence of my love of The Beatles and its alleged association with songs such as ‘Lucy in the Sky with Diamonds‘ (I say ‘alleged’ because all Beatle fanatics know that this song got its’ title from a drawing by John Lennon’s son Julian and that lyrically the song was inspired by the writings of Lewis Carroll, the creator of Alice in Wonderland [AIW], a book which gave its’ name to AIW Syndrome that I examined in a couple of previous blogs).
When I first started teaching my ‘Addictive Behaviours’ module back in 1990, almost all my lectures concentrated on drug addictions (as opposed to behavioural addictions which now take centre stage in my teaching), and it was my session on hallucinogenic drugs (also known as psychedelic drugs) that was always the most fun to teach and the topic that students appeared to be most engaged in. Like many of my students, I have always been interested in altered states of consciousness both in my own research into addiction and the topic more generally.
The reason why I mention all these things as that I did a media interview on the hallucinogenic effects of virtual reality products. The interview was based on comments by Microsoft researcher Mar Gonzalez Franco, who said that virtual reality will soon replace the need for hallucinogenic drugs. More specifically, she was quoted as saying:
“By 2027 we will have ubiquitous virtual reality systems that will provide such rich multi-sensorial experiences that will be capable of producing hallucinations which blend or alter perceived reality. Using this technology, humans will retrain, recalibrate and improve their perceptual systems…In contrast to current virtual reality systems that only stimulate visual and auditory senses, in the future the experience will expand to other sensory modalities including tactile with haptic devices“.
Claims that VR products have the potential to induce hallucinogenic experiences have already started appearing in the media. A recent story in the Daily Mail reported that there was already a VR app (SelfSound) that claimed it can reproduce the effects of hallucinogenic drugs and “plays on the neurological phenomena known as synaesthesia” and that a “program is used to promote mediation through creating abstract reality [and] plays face-melting music with synesthetic DMT-style visualizations uniquely generated in response to [a person’s] voice”. (DMT is an abbreviation for dimethyltryptamine, a powerful hallucinogenic drug).
Over the last seven years, I have published a series of studies with Dr. Angelica Ortiz de Gotari (some of them listed in the ‘Further reading’ section below) showing that hallucinations are common among video gamers in our working examining Game Transfer Phenomena (GTP). Therefore, it’s no surprise that VR games can do the same thing. We have reported that visual and auditory hallucinations are commonly experiences by regular videogame players.
For instance, one of our studies published in the International Journal of Human-Computer Interaction found that some video gamers experience altered visual perceptions after playing (e.g., distorted versions of real world surroundings). Others saw video game images and misinterpreted real life objects after they had stopped playing. Gamers reported seeing video game menus popping up in front their eyes when they were in a conversation, or saw coloured images and ‘heads up’ displays when driving on the motorway. Our study analysed 656 experiences from 483 gamers collected in 54 online video game forums. Visual illusions can easily trick the brain, and staring at visual stimuli can cause ‘after-images’ or ‘ghost images’ among videogame players. We found that GTP were triggered by associations between video game experiences, and objects and activities in real life contexts. Our findings also raised questions about the effects of the exposure to specific visual effects used in video games.
We also reported that in some playing experiences, video game images appeared without awareness and control of the gamers, and in some cases, the images were uncomfortable, especially when gamers could not sleep or concentrate on something else. These experiences also resulted in irrational thoughts such as gamers questioning their own mental health, getting embarrassed or performing impulsive behaviours in social contexts. However, other gamers clearly thought that these experiences were fun and some even tried to induce them.
Visual experiences identified in GTP show us the interplay of physiological, perceptual and cognitive mechanisms and the potential of learning with video games even without awareness. It also invites us to reflect about the effects of prolonged exposure to synthetic stimuli and the challenges that the human mind affront due to the technological advances that are still to come. However, because we collected our data for most of our published studies from online video game forums, the psychological profile of the gamers in our studies are unknown. However, different gamers reported similar experiences in the same games. This highlights the relevance of the video games’ structural characteristics but gamers’ habits also appear to be crucial. Some gamers may be more susceptible than others to experience GTP. The effects of these experiences appear to be short-lived, but some gamers experience them recurrently. It goes without saying (but I’ll say it anyway) that more research is needed to understand the cognitive and psychological implications of GTP. Most of these GTP experiences are viewed positively but a small minority of players find them detrimental.
Whether such hallucinations – either in typical videogames or VR videogames – can be induced on demand is debatable. Very few players in our own research said they were able to induce hallucinations. At present, we simply don’t know what the long-term effects of VR gaming will be and that goes for VR-induced gaming hallucinations too. It may be the case that VR induced hallucinogenic states will be ‘safer’ than ones induced by psychedelic drugs as there is no ingestion of a psychoactive substance, but that’s just speculation on my part.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Cawley, C. (2016). Virtual Reality could make you hallucinate; Don’t freak out. Tech Co, December 15. Located at: http://tech.co/virtual-reality-hallucinate-dont-freak-2016-12
Hamill, J. (2016). Windows of perception: Microsoft says virtual reality will soon have same mind-bending effects as LSD. The Sun, December 7. Located at: https://www.thesun.co.uk/news/2347705/microsoft-says-virtual-reality-will-soon-have-same-mind-bending-effects-as-lsd/
Liberatore, S. (2016). That’s trippy! Watch the VR app that claims to be able to reproduce the effects of a hallucinogenic drug. Daily Mail, May 4, Located at: http://www.dailymail.co.uk/sciencetech/article-3572184/That-s-trippy-Watch-VR-app-claims-able-reproduce-effects-hallucinogenic-drug.html
Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.
Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.
Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.
Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.
Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. In: Gamification: Concepts, Methodologies, Tools, and Applications (pp.1329-1345). Pennsylvania: IGI Global.
Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32, 470-480.
Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.
Rothman, P. (2014). Virtual Reality and Drugs – Yes, you should get high before using VR. H Plus Magazine, July 31. Located at: http://hplusmagazine.com/2014/07/31/virtual-reality-and-drugs-yes-you-should-get-high-before-using-vr/
Last month, the World Health Organisation (WHO) announced that it was planning to include ‘Gaming Disorder’ (GD) in the latest edition of the International Classification of Diseases. This followed the American Psychiatric Association’s decision to include ‘Internet Gaming Disorder’ in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. According to the WHO, an individual with GD is a person who lets playing video games “take precedence over other life interests and daily activities,” resulting in “negative consequences” such as “significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
I have been researching videogame addiction for nearly 30 years, and during that time I have received many letters, emails, and telephone calls from parents wanting advice concerning videogames. Typical examples include ‘Is my child playing too much?’, ‘Will playing videogames spoil my pupils’ education?’, ‘Are videogames bad for children’s health? and ‘How do I know if a child is spending too long playing videogames?’ To answer these and other questions in a simple and helpful way, I have written this article as a way of disseminating this information quickly and easily.
To begin with parents should begin by finding out what videogames their children are actually playing! Parents might find that some of them contain material that they would prefer them not to be having exposure to. If they have objections to the content of the games they should facilitate discussion with children about this, and if appropriate, have a few rules. A few aims with children should be:
- To help them choose suitable games which are still fun
- To talk with them about the content of the games so that they understand the difference between make-believe and reality
- To discourage solitary game playing
- To guard against obsessive playing
- To follow recommendations on the possible risks outlined by videogame manufacturers
- To ensure that they have plenty of other activities to pursue in their free time besides the playing of videogames
Parents need to remember that in the right context videogames can be educational (helping children to think and learn more quickly), can help raise a child’s self-esteem, and can increase the speed of their reaction times. Parents can also use videogames as a starting point for other activities like painting, drawing, acting or storytelling. All of these things will help a child at school. It needs to be remembered that videogame playing is just one of many activities that a child can do alongside sporting activities, school clubs, reading and watching the television. These can all contribute to a balanced recreational diet.
The most asked question a parent wants answering is ‘How much videogame playing is too much? To help answer this question I devised the following checklist. It is designed to check if a child’s videogame playing is getting out of hand. Ask these simple questions. Does your child:
- Play videogames every day?
- Often play videogames for long periods (e.g., 3 to 6 hours at a time)?
- Play videogames for excitement or ‘buzz’ or as a way of forgetting about other things in their life?
- Get restless, irritable, and moody if they can’t play videogames?
- Sacrifice social and sporting activities to play videogames?
- Play videogames instead of doing their homework?
- Try to cut down the amount of videogame playing but can’t?
If the answer is ‘yes’ to more than four of these questions, then your child may be playing too much. But what can you do if your child is playing videogames too much?
- First of all, check the content of the games. Try and give children games that are educational rather than the violent ones. Parents usually have control over what their child watches on television – videogames should not be any different.
- Secondly, try to encourage video game playing in groups rather than as a solitary activity. This will lead to children talking and working together.
- Thirdly, set time limits on children’s playing time. Tell them that they can play for a couple of hours after they have done their homework or their chores – not before.
- Fourthly, parents should always get their children to follow the recommendations by the videogame manufacturers (e.g., sit at least two feet from the screen, play in a well-lit room, never have the screen at maximum brightness, and never play videogames when feeling tired).
I have spent many years examining both the possible dangers and the potential benefits of videogame playing. Evidence suggests that in the right context videogames can have positive health and educational benefits to a large range of different sub-groups. What is also clear from the case studies displaying the more negative consequences of playing is that they all involved children who were excessive users of videogames. From prevalence studies in this area, there is little evidence of serious acute adverse effects on health from moderate play. In fact, in some of my studies, I found that moderate videogame players were more likely to have friends, do homework, and engage in sporting activities, than those who played no videogames at all.
For excessive videogame players, adverse effects are likely to be relatively minor, and temporary, resolving spontaneously with decreased frequency of play, or to affect only a small subgroup of players. Excessive players are the most at-risk from developing health problems although more research is needed. If care is taken in the design, and if they are put into the right context, videogames have the potential to be used as training aids in classrooms and therapeutic settings, and to provide skills in psychomotor coordination, and in simulations of real life events (e.g., training recruits for the armed forces).
Every week I receive emails from parents claiming that their sons are addicted to playing online games or that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen.” This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time.” I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.
(N.B. This article is an extended version of an article that was originally published by Parent Zone)
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Griffiths, M.D. (2003). Videogames: Advice for teachers and parents. Education and Health, 21, 48-49.
Griffiths, M.D. (2009). Online computer gaming: Advice for parents and teachers. Education and Health, 27, 3-6.
Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.
Griffiths, M.D., Kuss, D.J. & Pontes, H. (2016). A brief overview of Internet Gaming Disorder and its treatment. Australian Clinical Psychologist, 2(1), 20108.
Griffiths, M.D. & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39(4), 47-53.
King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.
King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.
Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.
Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.
Kuss, D.J. & Griffiths, M.D. (2012). Internet gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.
At the most recent Labour Party conference, the Party’s deputy leader Tom Watson said that if they formed the next Government they would introduce legislation to force gambling operators to pay a levy to fund research and NHS treatment to help problem gamblers deal with their addiction. This is something which I wholeheartedly support and is also something that I have been calling for myself for over a decade
The most recent statistics on gambling participation by the Gambling Commission in August 2017 reported that 63% of the British population had gambled in the last year and that the prevalence rate of problem gambling among those 16 years and over was 0.6%-0.7%. While this is relatively low, this still equates to approximately 360,000 adult problem gamblers and is of serious concern.
At present the gambling industry voluntarily donates money to an independent charitable trust (GambleAware) and most of this money funds gambling treatment (with the remaining monies being used to fund education and research). In the 12 months prior to March 2017, the gambling industry had donated £8 million, an amount still 20% below the £10 million a year I recommended in a report I wrote for the British Medical Association a number of years ago.
A statutory levy of 1% on all gambling profits made by the British gambling industry would raise considerably more money for gambling education, treatment and research than the £8 million voluntarily donated last year and is the main reason why I am in favour of it. Gambling has not been traditionally viewed as a public health matter. However, I believe that gambling addiction is a health issue as much as a social issue because there are many health consequences for those addicted to gambling including depression, insomnia, intestinal disorders, migraine, and other stress related disorders. This is in addition to other personal issues such as problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy.
There are also many recommendations that I would make in addition to a statutory levy. These include:
- Brief screening for gambling problems among participants in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons should be routine.
- The need for education and training in the diagnosis and effective treatment of gambling problems must be addressed within GP training. Furthermore, GPs should screen for problem gambling in the same way that they do for other consumptive behaviours such as cigarette smoking and alcohol drinking. At the very least, GPs should know where they can refer their patients with gambling problems to.
- Research into the efficacy of various approaches to the treatment of gambling addiction in the UK needs to be undertaken and should be funded by GambleAware.
- Treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded either by gambling-derived revenue (i.e., a ‘polluter pays’ model).
- Given the associations between problem gambling, crime, and other psychological disorders (including other addictions), brief screening should be routine for gambling problems should be carried out in alcohol and drug treatment facilities, mental health centres and outpatient clinics, as well as probation services and prisons.
- Education and prevention programmes should be targeted at adolescents along with other potentially addictive and harmful behaviours (e.g., smoking, drinking, and drug taking) within the school curriculum.
As I have tried to demonstrate, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. General practitioners routinely ask patients about smoking and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health. If the main aim of practitioners is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge in the training of those working in the health field.
Gambling is not an issue that will go away. Opportunities to gamble and access to gambling have increased due to the fact that anyone with Wi-Fi access and a smartphone or tablet can gamble from wherever they are. While problem gambling can never be totally eliminated, the Government must have robust gambling policies in place so that potential harm is minimized for the millions of people that gamble. For the small minority of individuals who develop gambling problems, there must be treatment resources in place that are affordable and easily accessible.
(N.B. This is a longer version of an article that was originally published in The Conversation)
Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.
Griffiths, M.D. (2003). Problem gambling. The Psychologist: Bulletin of the British Psychological Society, 16, 582-584.
Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.
Griffiths, M.D. (2006). The lost gamblers: Problem gambling. Journal of the Royal Statistical Society, 3(1), 13-15.
Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association
Griffiths, M.D. (2017). Gambling regulation from a psychologist’s perspective: Thoughts and recommendations. In Gebhardt, I. (Ed.), Glücksspiel – Ökonomie, Recht, Sucht (Gambling – Economy, Law, Addiction) (Second Edition) (pp. 938-944). Berlin: De Gruyter.
Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gambling in Europe: Challenges, Prevention, and Interventions. New York: Springer.
Regular readers will know that I love music and that two of my favourite bands include the Beatles and the Velvet Underground (both of who I have written blogs about including the VU’s lead singer Lou Reed, as well as blogs here, here, and here). Many would argue that the two bands couldn’t have been further apart musically especially given the Velvet Underground’s reputation as an ‘extreme’ band. However, I thought I would try and gather stories, anecdotes, and make my own observations on where the music and lives of members of the two bands connected in some way. Most of you reading this will know the four members of the Beatles (John Lennon, Paul McCartney, George Harrison, and Ringo Starr) but some of you may not know the original Velvet Underground members (Lou Reed, John Cale, Sterling Morrison, and Moe Tucker, plus Nico as vocalist on three songs on their first LP). These are presented in no particular order although towards the end of the list, the associations become more tenuous.
- Both bands released their seminal LPs in 1967 (Sgt. Pepper’s Lonely Hearts Club Band by the Beatles and Velvet Underground and Nico by the Velvet Underground). Both of the covers were designed by ‘pop artists’ (Peter Blake and Andy Warhol, the latter being VU’s manager at the time) and both are regarded as iconic LP cover art. The Velvet Underground were in the minority who didn’t like Sgt. Pepper and John Cale dismissed the LP as a “theatrical statement”. Lou Reed went even further and was quoted as saying “I never liked The Beatles. I thought they were garbage”.
- In 1993, Richard Witts (who before being an academic was the lead singer in one of my favourite 1980s band The Passage, and who I wrote about in a previous blog), published a biography about Velvet Underground vocalist Nico (Nico: The Life & Lies of an Icon). Witts claimed that in 1967 (May 19), Nico attended one of Beatles’ manager Brian Epstein’s private parties where he previewed the Pepper for the British media. Nico said in Witts’ book that: “There is a song I liked on Sgt. Pepper, called ‘A Day in the Life. It has a beautiful song and then this strange sound like John Cale would make (he told me it was an orchestra, actually) and then this stupid little pop song that spoils everything so far. I told this to Paul [McCartney], and I made a mistake, because the beautiful song was written by John Lennon and the stupid song was written by Paul. It can be embarrassing when you speak the truth.” Witts book also claimed that Nico briefly stayed with Paul McCartney at his London home during this particular May visit.
- In 1968, both the Beatles and the Velvet Underground released eponymous LPs (i.e., The Beatles by the Beatles and The Velvet Underground by the Velvet Underground). The eponymous Beatles LP is usually referred to as the ‘White Album’ and the eponymous Velvet Underground LP is sometimes referred to as the ‘Grey Album’. The other LP that the Velvet Underground released in 1968 (i.e., White Light/White Heat) was an all-black cover apart from the name of the group and the album title in white whereas the Beatles eponymous album was completely white apart from the name of the album in black). This is sometimes refereed to ‘The Black Album’.
- According to a number of Lou Reed’s biographers, the Beatles’ manager Brian Epstein really liked the Velvet Underground’s debut LP and (like David Bowie) was given a promo copy before it had actually been released. Epstein was approached by Steve Sesnick (the Velvet Underground’s manager after Andy Warhol) who contacted him hoping to get a deal for Velvet Underground songs with Epstein’s publishing company. It has also been claimed that Epstein was setting up a European tour for the Velvet Underground but Epstein died just before the contracts were signed (in fact Epstein died on my first birthday, August 27, 1967). According to Richie Unterberger (author of the excellent book White Light, White Heat: The Velvet Underground Day-By-Day), Reed actually met Epstein: “In a semicomic incident, Lou Reed himself met Brian Epstein around spring 1967 when, at publicist Danny Fields’s instigation, Reed finagled a cab ride with the Beatles manager in New York in the hopes that some interest in the VU’s affairs might be ignited. Evidently nothing came of it, however, other than Epstein sharing a joint with Reed and telling Lou how much he liked the banana album”.
- Lou Reed was a long-term client/patient of German (but New York-based) Dr. Robert Freymann. Freymann (also known as ‘Dr. Feelgood’) was the subject of the 1966 Beatles song ‘Dr. Robert’ on their Revolver.
- Both bands have individuals that are often claimed to be the ‘fifth member’. There are the ‘fifth Beatles’ (George Martin, Brian Epstein, Mal Evans, Billy Preston) and the ‘fifth VU member’ (Nico, Billy Yule, Andy Warhol).
- Anthony DeCurtis (author of the 2017 biography Lou Reed: A Life) speculates that Lou Reed’s song ‘The Day John Kennedy Died’ includes lyrics that are conflated with Reed’s memories of the day John Lennon died. More specifically, Reed wrote that he heard about Kennedy’s death while watching an American football match but there was no game on that day (12.30pm on November 22, 1963). However, on the day John Lennon died, sports broadcaster Howard Cosell announced that Lennon had been shot dead during his evening TV programme Monday Night Football.
- Lou Reed’s 1980 LP Growing Up In Public was recorded in Monserrat at Beatles’ producer George Martin’s studio.
- The Velvet Underground’s first manager, the rock journalist Al Aronowitz, was the man who first introduced the Beatles to Bob Dylan on August 28, 1964 (and George Harrison became Dylan’s life-long friend and were both in the Traveling Wilburys).
- Both ‘leaders’ of the Beatles and Velvet Underground wrote songs about heroin use from a personal perspective (‘Cold Turkey’ by Lennon and ‘Heroin’ by Reed). Other members of both bands experienced alcoholism (Ringo Starr and John Cale), and almost all members of both bands dabbled in various drug use (some very heavily) in the 1960s and 1970s.
- Lou Reed and John Lennon have both collaborated with David Bowie. Bowie produced Reed’s album ‘Transformer‘, sang on the track ‘Hop Frog’ (on The Raven LP), and and sang live on stage together in 1972 and 1997 (at Bowie’s 50th birthday concert at Madison Square Garden). Bowie co-wrote his No.1 US hit ‘Fame‘ with Lennon at the end of the Young Americans LP sessions (and in a previous blog, I looked at other associations between Bowie and the Beatles). John Cale also collaborated on two songs with Bowie (‘Velvet Couch’ and ‘Piano-la’) but these were never officially released and are only found on bootlegs).
- In the song ‘Rooftop Garden’ (the song that closes Reed’s Legendary Hearts LP), Reed used the line ‘Sitting in my rooftop garden, waiting for the sun’ in which he swapped the word ‘English’ for ‘rooftop’ from the line in ‘I Am The Walrus’.
- Both Lou Reed and Ringo Starr appeared as guests on the 1985 anti-apartheid protest song ‘Sun City’ single and accompanying video put together by Steven Van Zandt. Reed and Starr were also both inducted into the US ‘Rock ‘n’ Roll Hall of Fame’ in 2015.
- In 2011, Lou Reed and Paul McCartney both appeared on the same tribute album (Rave On) to Buddy Holly. Reed sang ‘Peggy Sue‘ and McCartney sang ‘It’s So Easy‘ (and McCartney earned money from both as he owns Holly’s back catalogue).
- Both Lou Reed and George Harrison have been heavily influenced in their lives by various aspects of Buddhism.
- Both John Lennon and Lou Reed spent the last decade of their lives living in New York (although Reed never lived in anywhere but New York) and both released albums with New York in the title (Some Time in New York City by Lennon and New York by Reed).
Dr. Mark Griffiths, Professor of Behavioural Addictions, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Bockris, V. & Malanga, G. (1995). Up-tight – The Velvet Underground Story. London: Omnibus Press.
DeCurtis, A. (2017). Lou Reed: A Life. London: John Murray.
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Kostek, M.C. (1992). The Velvet Underground Handbook . London: Black Spring Press.
Lewisohn, M. (1990). The Complete Beatles Chronicle. London: Harmony Books.
McNeil, Legs; McCain, G. (1996). Please Kill Me: The Uncensored Oral History of Punk. London: Grove Press.
Muggleton, D. & Weinzierl, R. (2003). The Post-Subcultures Reader. Oxford: Berg.
Norman, P. (2011). Shout! the Beatles in their generation. New York: Simon and Schuster.
Reed, L. (1992). Between Thought and Expression. London: Penguin Books.
Unterberger, R. (2011). White Light, White Heat: The Velvet Underground Day-By-Day. London: Edition Olms.
Wall, M. (2013). Lou Reed: The Life. Croydon: Orion Books.
Witts, R. (1993). Nico: The Life & Lies of an Icon. London: Virgin Books.
The advent of the Internet has enabled people’s engagement in a wide variety of online sexual behaviors. The Internet can provide a “safe” space for sexual exploration that presents less physical and social danger than offline activities, and may also provide access to a social community and a support system for non-normative gender and sexual expression (e.g., sexual fetishes and paraphilias). Additionally, a small minority of people may use the Internet excessively to engage in cybersex. Rather than being complementary, their use of cybersex may become a substitute for their offline sexual lives. For a small minority, their behaviors may take on addictive qualities that can be indicative of an online sexual addiction.
I noted in a number of papers that I published in the early 2000s (e.g., Journal of Sex Research  and CyberPsychology and Behavior ; see ‘Further reading’ below) that the Internet can be – and has been – used for a number of diverse activities surrounding sexually motivated online behavior. These include the use of the Internet for (i) seeking out sexually related material for educational use, (ii) buying or selling sexually related goods for further use offline, (iii) visiting and/or purchasing goods in online virtual sex shops, (iv) seeking out material for entertainment/masturbatory purposes for use online, (v) seeking out sex therapists, and (vi) seeking out sexual partners for an enduring relationship.
Other sexually motivated uses of the Internet include (i) seeking out sexual partners for a transitory relationship (i.e., escorts, prostitutes, swingers) via online personal advertisements/“lonely hearts” columns, escort agencies, and/or chat rooms, (ii) seeking out individuals who then become victims of sexually related Internet crime (online sexual harassment, cyberstalking, pedophilic “grooming” of children), (iii) engaging in and maintaining online relationships via email and/or chat rooms, (iv) exploring gender and identity roles by swapping gender or creating other personas and forming online relationships, and (v) digitally manipulating images on the Internet for entertainment and/or masturbatory purposes (e.g., celebrity fake photographs where heads of famous people are superimposed onto someone else’s naked body)
More recently, in a 2012 issue of the journal Addiction Research and Theory, I noted that online sexual behaviors can be classified as either cybersexual consumption (i.e., downloading and watching sexual content online such as pornography or reading sexual content in forums/chat sites without actively participating), or cybersexual interaction with others (e.g., text-based chat and/or video-linked conversations). Either of these types of online behavior may be accompanied by concurrent masturbation. Furthermore, online activities with a sexual component can be problematic for some because (1) they manifest sexual desires that the person (or their offline sexual partner) disapprove of or feel guilty about; (2) they divert (or distort) sexual energy from offline sexual behavior; and (3) the search for the ideal online sexual material may take up a great deal of time. Therefore, it appears necessary to distinguish not only between consumptive and interactive cybersex, but also between “normal” and “deviant” online sexual behaviors.
The late 1990s and early 2000s experienced a proliferation of studies investigating how human sexual behavior is enacted on the Internet. Some scholars (such as James Quinn and Craig Forsyth in a 2005 issue of the journal Deviant Behavior) claimed that technology transformed vicarious sex into an increasingly viable and attractive substitute for interpersonal forms of sexual fulfilment. Such an assertion suggests that a minority of cybersex users may use the Internet as a substitute for offline behaviours. It also suggests that what happens online may be very fulfilling for some people.
Sex on the Internet is particularly viable because of the inherent qualities of the Internet that the late Dr. Al Cooper referred to as the ‘Triple A Engine’ (access, affordability and anonymity). The online world, including explicit sexual material as well as potential online and offline sexual partners, can be accessed anytime and anywhere. Most of the time, sexual activities can be pursued at virtually no cost online, a point that demarcates online sex from offline sex, considering the expenditures involved in buying sex tapes or paying for sex workers. In comparison, the costs for bandwidth access are relatively low.
As an adaptation to Dr. Cooper’s Triple A Engine, Dr. Kimberley Young and colleagues proposed the ACE model, incorporating anonymity, convenience, and escape as factors salient to the Internet. These factors facilitate the engagement in sex by decreasing the inhibition thresholds present in offline sexual relations. Not only is a person anonymous online, but the Internet is ubiquitous and it can be accessed conveniently from a safe base, such as the person’s home.
Compared to offline sex, the Internet appears to offer the possibility to engage in cybersex anytime and anywhere for little financial cost. Therefore, research studies have found individuals are more likely to engage in risky sexual behaviors on the Internet rather than offline. The lower threshold associated with perceived lower risks of engaging in online sex may therefore increase the chance of persons who are at risk for developing sex addiction offline to actually develop sex addiction on the Internet. Empirical studies have increased our understanding of specific online sexual activities (e.g., Internet sex addiction). Here, the distinction between people who use Internet sex to improve their offline sex life and those who use it as a substitution may play an important role. Furthermore, cross-cultural differences point to the fact that the sociocultural context plays an important role in influencing people’s attitudes toward sexual behaviors.
In line with this, two potential scenarios materialize. First, one might assume that as views of sex are relatively liberal in some cultures relative to other more conservative cultures, members of the former may be more likely to engage in sex on the Internet because they have more open attitudes toward sexuality in general. Alternatively, particularly because some cultures are relatively conservative when it comes to sex, their members could potentially be more likely to engage in cybersex in order to compensate for the lack of freedoms in expressing their sexuality offline.
Note: This article used material previously published in the following book chapter: Griffiths, M.D. (2016). Internet sex. In Naples, N.A. (Ed.), The Wiley-Blackwell Encyclopedia of Gender and Sexuality Studies. Chichester: Wiley. DOI: 10.1002/9781118663219.wbegss408
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Cooper, A. (1998). Sexuality and the internet: Surfing into the new millennium. CyberPsychology and Behavior, 1, 187–193.
Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.
Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.
Griffiths, M.D. (2001). Sex on the internet: Observations and implications for internet sex addiction. Journal of Sex Research, 38(4), 333–342.
Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.
Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111–124.
Griffiths, M.D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the Internet and other issues. Addiction, 111, 2107-2109.
Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.
Quinn, J.F. & Forsyth, C.J. (2005). Describing sexual behavior in the era of the Internet: A typology for empirical research. Deviant Behavior, 26(3), 191–207.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.
Young, K., Pistner, M., O’Mara, J. & and Buchanan, J. (1999). Cyber-disorders: A mental health concern for the new millennium. CyberPsychology and Behavior, 3(5), 475 – 479.
About a year ago, my colleagues and I published what we believe is the very first study of the helping role that video gaming can play in the lives of transgender individuals. Before I get to that, it’s probably worth noting that there have been studies of how gamers and fans play with sexuality, gender, and the video game Minecraft on YouTube as well as papers discussing whether the gaming industry should cater for marginalized groups and develop games for groups where there is little representation within games (e.g., gay and transgendered characters). For instance, there is now a short autobiographical game by Auntie Pixellante called Dys4ia. This is a WarioWare-style game, played only with the arrow keys, chronicling the experiences of a trans woman rectifying her own gender dysphoria. Such videogames raise interesting questions about how those individuals with gender dysphoria utilize gaming as part of their identity.
In a previous blog I briefly looked at gender swapping in online video games including some of my own research. For instance, in 2003 I published a paper in the journal CyberPsychology and Behavior using secondary poll data from online gaming forums. The paper reported that of 10,350 players at the Everlore fan site, 15% had swapped the gender of their main in-game playing character. We also reported a similar finding among 8,694 players at the Allakhazam fan site with 15.5% reporting that they had gender swapped their main in-game character (and more specifically, 14.5% males and 1% were females who had changed the gender of their lead character). In a 2004 follow-up survey among 540 Everquest gamers (again in the journal CyberPsychology and Behavior) my colleagues and I reported that 60% had swapped their online in-game characters. The prevalence of gender swapping was probably much higher in this study because the question related to the gender swapping of any online game character not just their main playing character.
In a small exploratory study I published in 2008 with Dr. Zaheer Hussain in the International Journal of Mental Health and Addiction, we examined why people engaged in gender swapping in a self-selecting sample of 119 online gamers (mean age of 28.5 years). We reported that 57% of gamers had engaged in gender swapping (any character not just their main character), and that males adopting an online female persona believed there were a number of positive social attributes to becoming female characters in male-oriented gaming environments. The study also reported that significantly more females than males had gender swapped their character – mainly to prevent unsolicited male approaches on their female characters. Some females appeared to gender swap purely out of interest to see what would happen in the game (as a personal experiment), while others claimed that they were treated more favourably by male gamers when they played as a male character. Others reported that gender swapping enabled them to play around with aspects of their identity that would not be possible to explore in real life. Other reasons for gender swapping were that (i) female characters had better in-game statistics, (ii) some specific tools were only available with female characters, (iii) the class of character was sometimes only available in one gender, (iv) they played for fun, and/or (v) they did it to so something that they would not normally do in the game (i.e., they did it for a change in their usual playing behaviour).
Outside of online gaming, a 2002 paper by Hegland and Nelson in the International Journal of Sexuality and Gender Studies noted that the Internet more generally can be used as a tool for expressing gender identity because it allows identities to cross cultural boundaries instantly and without regard for real physical space. They examined 30 cross-dressing websites and argued that for most cross-dressers that visited such websites, the online forum was their primary medium of expression. The users of the website used the Internet to nurture the ability to create a feminine identity, and helped them to pass as a woman in the offline public world. More generally, cross-dressers used the Internet to participate in the larger cultural dialogue of gender.
For an adult to meet current criteria for a diagnosis of transsexualism, the World Health Organisation’s International Classification of Diseases (ICD) reports they must express the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the desired sex through surgery and cross-sex hormones. This transsexual identity must have been present persistently for a minimum of two years and not be a symptom of another mental disorder or a chromosomal abnormality. The latest (fifth) edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association uses the term gender dysphoria to describe people who are uncomfortable and/or distressed regarding their assigned gender, their physical sex characteristics and/or their associated social roles. Depending upon the intensity of this distress, some individuals may wish to transition from one point on a notional gender scale to another. The most common direction is from a man to a woman (individuals known as trans women), or from a woman to a man (individuals known as trans men). The distress intrinsic to gender dysphoria may be focused around anatomy, physiology, and/or being perceived and treated as someone of a gender with which the person does not identify. However, these diagnostic labels do not apply to all trans individuals for a multitude of reasons because some people will not identify themselves as a man or as a woman
The World Health Organisation working group has recommended that the latest ICD replace the term Transsexualism with Gender Incongruence) and remove it from the mental and behavioural disorders chapter. Gender incongruence denotes the incongruence between a person’s gender identity and their assigned sex and/or congenital primary and secondary sex characteristics. The terminology in this field has changed over the years and the terms ‘transgender’ and ‘trans’ have been used in the literature as umbrella terms to cover a wide variety of atypical gender experiences and expressions which may lead to permanent change of social gender role but does not necessarily involve treatment with cross-sex hormones or surgical intervention. A recent study has reported an prevalence for transsexualism of 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men, which is primarily based on studies looking at individuals attending clinical services. (However, it should be noted that recent population studies have reported a significantly higher prevalence rate of atypical gender experiences and expressions).
The study we published in the journal Aloma originated from initial observations made by Dr. Jon Arcelus that a number of gender dysphoric clients presenting at the national (UK) gender dysphoria clinic admitted that they gender-swapped while playing online games. After I met with Dr. Arcelus I suggested he revisit his case files and and to write them up as case studies (as no study in the gaming field has ever examined online gaming among those with gender dysphoria). The main objectives of our study were to use exemplar case studies to highlight that gaming – in some circumstances – appears to be a functional way of dealing with gender identity issues, and that gender swapping in gaming may help such individuals to come to terms with their gender dysphoria.
Our paper featured four case studies who attended an assessment at the National Centre for Gender Dysphoria in Nottingham. All four individuals described in our paper were given pseudonyms and the content of their histories were anonymised (and included ‘Mary’ a 26-year old natal male who fully transitioned to the female social role six months prior to our study; ‘Mark’ a 20-year old natal female who first attended for an assessment in the female role; ‘Paul’ a 31-year old natal male who would like to be female, but still living full-time as a male; and ‘Harry’ a 23-year old natal male who presented for an assessment as a male). If you want to read about each case in detail, the paper can be downloaded for free from here).
The four case studies outlined in our paper are only a selected sample of the number of cases attending a national clinic for people with gender dysphoria. However, they were in no way unusual to the other clients that have sought help at the Centre. However, these individual accounts were specifically selected to demonstrate the different ways that video gaming may help people with gender dysphoria come to terms with their gender identity. For example, gaming can be used among trans people as a psychological tool to increase one’s awareness of gender identity and/or as part of the self. Gaming may therefore be a useful way to express one’s experienced gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. This appears to mirror other the findings of other studies outside of the online gaming environment.
Articles published in the mass media have reported that online games such as World of Warcraft provide a creative space that allows gamers that might be questioning aspects of their identity to explore their lives as different individuals. Some have even gone as far as to argue that this could help gamers transform their ‘offline’ identity, as is the case with some trans gamers. This was also demonstrated in the case studies described in our study. Other authors have asserted that the online medium offers an infinite space for development and resistance to traditional gender roles, and that online interaction enables a transgression of the dichotomous categories of male and female, constructing trans (or even genderless) social identities and relationships. However, although such anonymous online communities may provide trans individuals with the power to subvert their physical sex.
Our case studies also demonstrated the different functions of gaming in trans people (e.g., the function of “testing out” their gender feelings). For instance, using gaming to ‘come out’ to other people, by initially coming out in the online community, which is perceived as a safe environment, and then gradually coming out in real life. Gaming, as for many non-trans individuals, can derive psychological benefits and a sense of escapism. This is even more relevant among trans people as it may be the only time that they feel they can be themselves, allowing them to feel happy, relaxed, and achieving a sense of completeness. This could develop into a powerful coping skill substituting unhealthy behaviours, such as self-harming behaviour. This is particularly important in this population as research shows a strong association between being trans and mental health problems, particularly depression and self-harm as a way to manage one’s trans feelings. This is not surprising as the discomfort and distress about assigned gender and body dissatisfaction may lead to a sense of hopelessness, which can bring low mood, self-injury and even suicide.
Although gaming appears (at least initially) to be a positive and beneficial activity for many trans people, there is also the risk that staying in the game becomes too much of a secure and safe environment. This can create a vicious circle where the trans person does not wish to move out of the secure online world, and back into reality. Spending an increasing amount of time in online gaming carries the risk of developing a gaming dependence or addiction. This may not only affect one’s personal relationships, work and/or study, but may also impair real life social gender role transition, as in many cases, the individual is expected to socially transition before they can be considered for treatment.
Obviously our paper only included four participants and may be perceived by some researchers as ‘anecdotal’ because the data were not collected for this specific study but were retrospectively collated. However, our findings showed that for a trans individual, the online gaming environment was perceived as “safe” but further research is needed to establish what the distinctive elements of online gaming are that help to raise gender awareness (or not as the case may be). With the rates of gender dysphoria attending clinical services increasing significantly, future research should investigate (i) the rates and severity of gaming among this population as well as its function, and (ii) the rates of gender dysphoria among game addiction as coming out may help their addiction. The game industry may also want to consider how they can use games as a way of helping trans people being more accepted within society by developing game industry may want to co-observe how their games can prepare and assist individuals to socially transition. Online games also provide a safe environment that provides people access to a platform where individuals can discuss and experiment with gender identity.
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