Geek or chic? A brief look at video gamer stereotypes

Regular readers of my blog will know that I have spent well over two decades carrying out research into various aspects of video gaming. Online video gaming has become an increasingly popular activity amongst teenagers and adults alike. For numerous reasons, perhaps in part because of its rapid growth, online gaming is also an activity that has become highly stereotyped. That is, it is an activity that has come to be associated in popular culture with a highly specific, caricatured and also negative image. This image is reflected in numerous television shows, print media, news reports, current affairs programs and other sources of popular culture. As Dr. D Williams and his colleagues noted in a 2008 issue of the Journal of Computer-Mediated Communication Monographs:

“Game players are stereotypically male and young, pale from too much time spent indoors and socially inept. As a new generation of isolated and lonely ‘couch potatoes,’ young male game players are far from aspirational figures”.

Understanding the formation of stereotypes about this group and how they are internalised may help us understand society’s attitudes towards this activity and how its participants are positioned within the status hierarchy. Where the stereotype of the pale teenage gamer came from and whether there is any truth to it are clearly important and interesting questions. Our recent research concerns the extent to which this social stereotype has been transformed into a cognitive stereotype, what form this cognitive stereotype takes, and what this can tell us about society’s attitude toward gaming as an emerging form of social or asocial activity.

Within popular culture, a clear characterisation of online gamers has emerged. Frequently caricatured, this ‘stereotype’ has been disseminated throughout the print media, as well as television and web based programs. One poignant example comes from the popular U.S. animated series South Park. In an episode devoted to the Massively Multiplayer Online Role Playing Game (MMORPG) World of Warcraft, the stereotypical gamer was portrayed as overweight, lazy, isolated, and aggressive. Additionally, the four main characters of the series became increasingly overweight, lazy, and developed acne as their immersion into the game deepened. One of the main characters (Penny) in the U.S. television series The Big Bang Theory also conforms to stereotypic expectations as she becomes obsessive, reclusive and unkempt upon playing a fantasy-based online game.

The highly successful web series, The Guild, took a more comical approach as they followed a group of online gamers who decide to meet each other in the offline world after many months of regular online interaction. In the opening scene of the first episode, the main character is told by her therapist that her online friends do not constitute a genuine support system, and that immersion in an imaginary social environment is stunting her personal growth. Within the first few minutes of this episode, themes of obsession, addiction, reclusiveness, and loneliness arise.

The stereotypical portrayal of an online gamer has also taken more serious forms. In an episode of Law and Order: SVU, a popular U.S. television series, two individuals are arrested and accused of neglecting their child due to their immersion in an online gaming world. In addition to the depiction of the more physical aspects of the stereotype (both suspects are overweight and have poor personal hygiene), the obsessive and addictive qualities of online gaming are implicated in a much more serious context of child neglect.

The problematic and addictive nature of video games is often highlighted by the news media, and a variety of internet websites, magazine articles, and news articles dispense advice for individuals with problematic playing behaviours. Taken together, these media portrayals, news reports, and internet articles present a consistent and negative image of online gaming and its participants. Online gaming is presented as a dangerous activity that may lead to social withdrawal, physical and mental ill health, and even suicide. These concerns are reflected in stereotypical portrayals of online gamers as socially anxious and incompetent, mentally stunted and withdrawn, and physically unhealthy (e.g., overweight, pale). The origins of this stereotypical image are unknown. It may be an extension of pre-existing stereotypes about similar activities (e.g., the violent film or video game and aggression hypothesis), a subtype of a broader ‘nerd’ stereotype, or a general cynicism about a new and rapidly spreading form of social activity and interaction. The social, psychological and historical factors that led to this stereotype are clearly interesting and worth exploring.

The occurrences of the cultural stereotype described are largely examples of the stereotype of an MMORPG player, rather than online gamers more generally. MMORPG players appear to be the prototype of online gamers, as caricatured by numerous television and web-based programs. In a study published in the Bulletin of Science, Technology and Society, Dr. Rachel Kowert, Dr. Julian Oldmeadow and myself collected some data on video gamer stereotypes. We asked our participants (both gamers and non-gamers) to indicate what most other people think online gamers are like. To the extent that stereotypical portrayals of online gaming and gamers have given rise to shared trait associations, there should be strong agreement across both gamers and non-gamers with regards to how gamers are perceived by others in general. A further aim of our study was to examine the extent to which these trait associations about gamers have been internalised as personal beliefs. A total of 342 participants completed our online survey in which they rated how applicable each of a list of traits was to the group of online gamers. Ratings were made for both personal beliefs (how participants themselves see gamers) and stereotypical beliefs (how most others see gamers). While these beliefs were highly consensual as stereotypes, personal beliefs varied suggesting that the cultural portrayal of online gamers is beginning to shift into cognitive associations.

Participants were asked to evaluate the list of adjectives and rate each one in terms of how applicable they believed the trait to be of online gamers. Responses were given on a 7-point Likert-type scale, ranging from 1 (“not at all applicable”) to 7 (“very applicable”). Participants were first asked questions relating to basic demographic information, as well as information about their online gaming habits (which games they play or had played, frequency of play, and whether they consider themselves a gamer). They were then asked to rate each of the 30 adjectives according to how they personally perceived online gamers (stereotype endorsement), and how they thought other people perceive online gamers (stereotype). The tasks were presented in this order to maximise the independence between personal and stereotypical ratings.

Even though online gamers are a relatively new social category within society, our results demonstrated that a collective stereotype about this population has emerged. All our participants showed an awareness of a shared stereotype that is in accordance with the anecdotal characterisations commonly portrayed by popular media. Stereotype ratings were consistent across gamers and non-gamers, suggesting that these beliefs are widely shared within society. Based on the results of this study, we concluded that the current stereotype of online gamers is largely negative, based on the traits of popularity, attractiveness, idleness, and social competence. Online gamers were stereotypically viewed as unpopular, unattractive, idle, and socially incompetent, a characterisation that seems to match common stereotypical portrayals in the media, television, and internet articles.

As this investigation was largely exploratory, care needs to be taken in interpreting the results and further research is needed to confirm the factors that emerged here. For instance, it is uncertain if the results found here are reflective of the generalized stereotype of gamers (including online gamers more generally) or the popularized prototype of the MMORPG gamer. While some have found that MMORPG gamers are viewed more negatively than the generalized construct of the online gamer, future research is needed to further examine the general stereotype in relation to the subgroups contained within it. This will hopefully provide clarification into the stereotypical differences amongst the broad categorization of online gamers as compared to more specific subgroups, such as MMORPG gamers or casual online gamers (e.g., individuals who play online games that require no major time commitment or special set of skills to complete, such as the highly popular Zynga game, Farmville). Future research may provide further insight into the progression of the shared beliefs about online gamers ‘out there’ developing into internalised cognitive associations ‘in here’. Somewhat fortuitously, the stereotype of online gamers is still undergoing formation within society, providing researchers with the unique opportunity to study this characterisation as it continues to evolve.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input: Dr. Rachel Kowert and Dr. Julian Oldmeadow

Further reading

Cole, H., & Griffiths, M. (2007). Social Interactions in Massively Multiplayer Online Role-Playing Games. CyberPsychology and Behavior, 10(4), 575 – 583.

Griffiths, M., Davies, M., & Chappell, D. (2003). Breaking the stereotype: the case of online gaming. CyberPsychology and Behavior, 6(1), 81 – 91.

Kowert, R., Griffiths, M.D. & Oldmeadow, J. (2012). Geek or Chic? Emerging stereotypes of online gamers. Bulletin of Science, Technology and Society, 32, 371-379.

Kowert, R., & Oldmeadow, J. (2012). The stereotype of online gamers: new characterization or recycled prototype. Paper presented at the Nordic DiGRA, Tampere, Finland.

Lucas, K., & Sherry, J. (2004). Sex differences in video game play: a communication-based explanation. Communication Research, 31(5), 499 – 523.

Ogletree, S., & Drake, R. (2007). College students’ video game participation and perceptions: gender differences and implications. Sex Roles, 56, 537 – 542.

Williams, D., Yee, N., & Caplan, S. (2008). Who plays, how much, and why? Debunking the stereotypical gamer profile. Journal of Computer-Mediated Communication Monographs, 13(4), 993 – 1018.

Yee, N. (2006). The demographics, motivations, and derived experiences of users of massively-multi-user online graphical environments. Teleoperators and Virtual Environments, 15(3), 309 – 329

Flying high? Is the playing ‘Flappy Bird’ excessively something to worry about?

The following blog is an expanded version of an article that first appeared in Nottingham Trent University’s Expert Opinion column

A few weeks ago I was introduced to the game Flappy Bird by my kids while celebrating the 80th birthday of their grandma. Within an hour, everyone – from the toddlers to the octogenarians – was playing it. Flappy Bird is another one of those free games that is very hard to put down once you start playing it. The game’s premise is so simple, almost banal – just keeping a bird flying by tapping one finger on the touch screen of a phone or tablet and guiding the bird between a series of pipes with gaps. For each gap in a pipe that the bird flies through, the player gets one point. Hitting or touching a pipe – or touching the ground – and it’s game over. Embarrassingly, I have yet to get into double figures. As one media commentator noted, it’s a game you love to hate – but end up just loving it!

Do a quick Google search on Flappy Bird and the one phrase that keeps coming up is that the game is “infuriatingly addictive” – and I couldn’t agree more. As soon as the game is over, the only way I can dissipate the feeling of frustration, annoyance, and anger of not doing very well is to play again immediately. For those that do well, they immediately want to play again to beat their high score. As one reviewer of the game noted:

“I was perusing the App Store, as one often does, when I noticed a new title sitting at the top of the free app chart. I decided to download it and take it for a spin as, if it is the most popular free app at the moment, it must at least be worth a look. From that point forward, that title – Flappy Bird – irritated the hell out of me and I couldn’t stop playing it…So, why can’t I stop playing? I’m actually not entirely sure myself. Maybe it’s that the game is incredibly easy to pick up and play. The one-finger gameplay is easy to grasp immediately but Flappy Bird is ridiculously difficult from the get go. Making it through a few sets of pipes feels like a humongous achievement as crashing is so much easier – it’s almost as if the game starts off at the highest difficulty level and just remains that way rather than gradually becoming more challenging. After a few hours playing Flappy Bird a double-digit score would probably be all you could expect. Then there is the ease in which you can start the next game immediately after failing your last effort. As soon as one game ends you can be into the next one in seconds making for an incredibly addictive experience. Each attempt is frustrating and you think you can do better next time, or at least prove that you’re not an idiot incapable of simply guiding a bird past some pipes… Despite all of its obvious and irritating flaws, Flappy Bird remains incredibly addictive and is certainly worth taking a few minutes to check out (although that few minutes may well turn into a few hours). I found that playing it was fun as well as frustrating and, if I’m being totally honest, the game fulfils its own mission entirely. It’s a simple arcade game but unique in its incredible difficulty, just as the developer’s clearly intended.

Earlier this month, the game’s creator, Dong Nguyen, withdrew Flappy Bird from online app stores – even though he was earning over 50,000 a day via in-app advertising revenue. He was quoted as saying:

“Flappy Bird was designed to play in a few minutes when you are relaxed. But it happened to become an addictive product. I think it has become a problem. To solve that problem, it’s best to take down Flappy Bird. It’s gone forever.”

As someone that has spent over 25 years researching into video game play, Flappy Bird is the latest in a long line of fun and deceptively simple games that someone can end up playing for hours on end. The game is gender-neutral and has a ‘moreish’ quality (a bit like chocolate in that it’s really hard just to eat one piece) and can fit in flexibly around what individuals do in their day-to-day life. Most simple games like Flappy Bird take up all the player’s cognitive ability because anyone playing on it has to totally concentrate on it. By being totally absorbed players can forget about everything else for a few minutes. This can be particularly appealing for players that want to use games as a way of temporarily forgetting about everything else that’s going on in their lives. One video game review I came across said:

“Flappy Bird is the latest weirdly addicting game to captivate mobile users. The reason is simple, if not straightforward. In the guise of a cartoonish time-waster, Flappy Bird offers some of the most punishing, hardcore gameplay you can imagine. And it’s sucking in players by the millions”.

Psychologically, casual games like Flappy Bird rely on both positive and negative reinforcement over speedy gameplay. I have noted that many games played via social networking sites that ‘freemium’ games are psychological ‘foot-in-the-door‘ techniques that lead a small minority of people to pay for games and/or game accessories that they may never have originally planned to buy before playing the game (akin to ‘impulse buying’ in other commercial environments). I’ve also argued that many casual games share similarities with gambling. On first look, games like Flappy Bird may not seem to have much connection to gambling, but the psychology is very similar. Even when games do not involve money, they introduce players to the principles and excitement of gambling. Small unpredictable rewards lead to highly engaged, repetitive behaviour. In a minority, this may lead to addiction. Basically, people keep responding in the absence of reinforcement hoping that another reward is just around the corner (a psychological principle rooted in operant conditioning and called the partial reinforcement extinction effect – something that is used to great effect in both slot machines and most video games).

Physiologically, these games are likely to increase dopamine levels when people are doing well whereas and failure will most likely cause an increase in noradrenaline. The interaction of two competing neurotransmitter systems is likely to keep players engaged in the game for periods longer than they originally intended. In short, the games are ingeniously simple, highly enjoyable, and (as some players describe them) “emotionally intoxicating”. I’ve only ever come across a few people that I would define as genuinely addicted to these games but all the ingredients are there to make it theoretically possible for almost anyone to be psychologically seduced by such games.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (2010). Online gambling, social responsibility and ‘foot-in-the-door techniques. i-Gaming Business, 62, 100-101.

Griffiths, M.D. (2010). Gaming in social networking sites: A growing concern? World Online Gambling Law Report, 9(5), 12-13.

Griffiths, M.D. (2012). The psychology of social gaming. i-Gaming Business Affiliate, August/September, 26-27.

Griffiths, M.D. (2013). Social gambling via Facebook: Further observations and concerns. Gaming Law Review and Economics, 17, 104-106.

Hall, C. (2013). Just how addictive are mobile games? Yahoo! News, October 18. Located at: http://uk.news.yahoo.com/how-addictive-are-mobile-games–143654713.html#P1M3U7a

Lagorio-Chaflkin, C. (2013). Candy Crush Saga’s intoxicating secret source. Inc.com, July 25. Located at: http://www.inc.com/christine-lagorio/candy-crush-secret-sauce.html

Rose, M. (2013). Chasing the Whales: Examining the ethics of free-to-play games. Gamasutra, July 9. Located at: http://www.gamasutra.com/view/feature/195806/chasing_the_whale_examining_the_.php?page=7

Carry on screening: A brief look at Internet Gaming Disorder

In this month’s issue of the Neuropsychiatry journal, I – and my research colleagues (Dr. Daniel King and Dr. Zsolt Demetrovics) – published a paper arguing that Internet Gaming Disorder needs a unified approach to assessment. Over the last 15 years, research into various online addictions has greatly increased. Prior to the publication of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, there had been some debate as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has also been debate as to whether those researching in the online addiction field should be researching generalized internet use and/or the potentially addictive activities that can be engaged on the internet (e.g., gambling, video gaming, sex, shopping, etc.)

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien writing in a 2013 issue of Addiction, IGD will not be included as a separate mental disorder until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that IGD was not included in the main text of the DSM-5 was that the SUDWG concluded that no standard diagnostic criteria were used to assess gaming addiction across these many studies. A 2013 overview of instruments assessing problematic gaming by my colleagues and I in Clinical Psychology Review reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. This comprehensive review identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the: (i) the brevity and ease of scoring, (ii) excellent psychometric properties such as convergent validity and internal consistency, and (iii) robust data that will aid the development of standardized norms for adolescent populations. However, the main weaknesses identified in the instrumentation included: (i) core addiction indicators being inconsistent across studies, (iii) a general lack of any temporal dimension, (iii) inconsistent cut-off scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or dimensionality. It has also been noted by a number of authors that the criteria for IGD assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioral addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental and neurobiological research settings.

Video gaming that is problematic, pathological and/or addictive (i.e., IGD) lacks a widely accepted definition. In a recent book chapter (in the 2014 book Behavioral Addictions: Criteria, Evidence and Treatment edited by Dr. Ken Rosenberg and Dr. Laura Feder), I and some of my Hungarian colleagues argued that some researchers consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. Recent studies have made an effort to integrate both approaches Consequently, IGD can either be viewed as a specific type of video game addiction, or as a variant of internet addiction, or as an independent diagnosis.

As I argued in one of my previous blogs, although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and this likely reflects a common etiology of addictive behavior. Consequently, online game addiction may be viewed as a specific type of video game addiction. Similarly, Dr. G. Porter and colleagues in a 2010 issue of the Australian and New Zealand Journal of Psychiatry, do not differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. However, unlike my conceptualization of gaming addiction, their criteria for problematic video game use does not include other features usually associated with dependence or addiction, (e.g., tolerance, physical symptoms of withdrawal), as they say there is no clear evidence that problematic gaming is associated with such phenomena. Researchers such as Dr. Kimberley Young view online gaming addiction as a sub-type of internet addiction and that the internet itself provides situation-specific characteristics that facilitate gaming becoming problematic and/or addictive.

In a 2010 issue of Computers in Human Behavior, Dr. M.G. Kim and Dr. J. Kim’s [11] proposed a Problematic Online Game Use (POGU) model that takes a more integrative approach and claims that neither of the approaches outlined above adequately capture the unique features of online games such as Massively Multiplayer Online Role Playing Games (MMORPGs). They argue that the internet is just one channel where people may access the content they want (e.g., gambling, shopping, sex, etc.) and that such users may become addicted to the particular content rather than the channel itself. This is analogous to the argument that I made over 15 years ago in a number of different papers that there is a fundamental difference between addiction to the internet, and addictions on the internet. However, MMORPGs differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

The POGU model resulted in five underlying dimensions of addictive gameplay (i.e., euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship). I also support the integrative approach and stress the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). The POGU model comprises six dimensions (i.e., preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal).

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the IGD criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (1) preoccupation with internet games [salience]; (2) withdrawal symptoms when internet gaming is taken away [withdrawal]; (3) the need to spend increasing amounts of time engaged in internet gaming [tolerance], (4) unsuccessful attempts to control participation in internet gaming [relapse/loss of control]; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]; (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict]; (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict]; (8) use of the internet gaming to escape or relieve a negative mood [mood modification];  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].

The fact that IGD was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, Dr. B. Koronczai and colleagues in a 2011 issue of Cyberpsychology, Behavior and Social Networking, asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Such an instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of IGD as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. It was also noted that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity. To fulfill all these requirements, future research should adjust the currently used assessment tools to the newly accepted DSM-5 criteria and take much more efforts to reach and study clinical samples, which is an unequivocal shortcoming of both internet and gaming research.

In addition to further epidemiological and clinical research, further research is also needed on the neurobiology of IGD. A systematic review of 18 neuroimaging studies examining internet addiction and IGD by Dr. Daria Kuss and Griffiths in a 2012 issue of Brain Sciences noted that:

“These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains” (p.347).

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. We noted in our 2013 Clinical Psychology Review paper that across many different studies, IGD is commonly defined by (a) withdrawal, (b) loss of control, and (c) conflict. However, it is critical that a unified approach to assessment of IGD is urgently needed as this is the only way that there will be a strong empirical basis for IGD to be included in the next DSM.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

King, D.L., Haagsma, M.C.,Delfabbro, P.H.,Gradisar, M.S.^, Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2013).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

Pápay, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment. New York: Elsevier.

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

No time for the crime: Excessive adolescent video game playing, social networking and crime reduction

On Sunday February 9, 1964, The Beatles made their debut on US television. Their appearance on the Ed Sullivan Show drew an estimated audience of 73 million people. One of the most quoted consequences associated with this particular show was that between 8pm and 9pm when the show was aired, a number of news reports claimed that there was no reported incidence of juvenile crime across America during the time of the broadcast.  The editor of Newsweek, B.F. Henry, went as far as to claim that “there wasn’t so much as a hubcap stolen” during the hour that The Beatles were on the show.

This apocryphal tale, at the very least, shows the apparent compelling logic in the argument that when an activity is so engrossing it has the capacity to stop people engaging in other types of activity such as crime. Inspired by a speculative blog post on the topic, my friend and research colleague Dr. Mike Sutton failed to disconfirm what Dr. Sutton and I have called the Crime Substitution Hypothesis. We recently published a small paper in the journal Education and Health that examined the extent to which popular youth activity (namely video gaming and social networking) may be having an effect on youth offending and victimization.

Young people’s use of technology (the so called ‘screenagers’ and ‘digital natives’) has increased greatly over the last two decades and a significant proportion of daily time is spent in front of various screen interfaces most notably videogames, mobile phones (e.g., SMS) and the internet (e.g., social networking sites like Bebo, Facebook). These ‘digital natives’ have never known a world without the internet, mobile phones and interactive television, and are therefore tech-savvy, have no techno-phobia, and very trusting of these new technologies.

One of the most empirically researched areas is in the area of adolescent video gaming. Negative consequences of gaming have included addiction, increased aggression, and a variety of medical consequences, such as repetitive strain injuries, obesity, and photosensitive epilepsy. There is certainly evidence that when taken to excess, videogame playing can in some cases be addictive, especially online videogame playing where the game never pauses or ends, and has the potential to be a 24/7 activity. However, there are many reported benefits that adolescents can get from playing videogames. These can be educational, social and/or therapeutic.

Another positive benefit of playing video games along with activities like social networking may be the capacity to reduce youth crime. The reason why videogames may have implications for crime reduction is their use as ‘distractors’ (such as in the role of pain management). The reasoning is that ‘distractor tasks’ consume some degree of the attentional capacity that would otherwise be devoted to pain perception. I have noted in a number of my academic papers that the main reasons that videogames make good distractors are because they:

• Are likely to engage much of a person’s individual active attention because of the cognitive and motor activity required.
• Allow the possibility to achieve sustained achievement because of the level of difficulty (i.e. challenge) of most games during extended play.
• Appear to appeal most to adolescents

For instance, one study reported the case of an eight-year-old boy with neurodermatitis being given a handheld videogame to prevent him from picking at his face. Where previous treatments had failed, the use of the game kept his hands occupied and within two weeks the affected area had healed. A number of studies have demonstrated that videogames can provide cognitive distraction for children undergoing chemotherapy. All these studies have reported that distracted child patients report less nausea after treatment (when compared with control groups), and that playing videogames reduced the amount of painkillers the children needed during treatment. The very reasons why video games may be of benefit therapeutically may also be applied to video games in a crime reduction context (i.e., the playing of video games is so cognitively distracting that that there is little time to do or think about anything else).

Consequently, there is a developing school of thought arguing that peoples’ participation (especially excessive use) in video gaming and social networking may be contributory factors that may partly explain the fall in crime rates in recent years. For instance, the economist Larry Katz was quoted in a 2010 issue of The Economist suggesting that the playing of video games may be playing a role in crime reduction. Katz’ reasoning is simple – keeping people busy keeps them out of trouble. There appears to be some statistical support for such a hypothesis as the decrease in US crime rates appears to show an inverse correlational relationship with increased sales of video game consoles and video games. Clearly this correlational evidence should be treated with caution as it says nothing about causation. However, it does provide a hypothesis that could be the subject of future empirical testing.

Could the rise in video game playing and social networking be a major cause of what criminologists claim is an unfathomable drop in crime, and if not, then why not? Routine Activity Theory predicts that if a substantial numbers of young people are not on the streets either as victims or offenders then overall high volume ‘crime opportunities’ would diminish, resulting in an overall drop in high volume crime rates. We have no idea yet whether what we might call the ‘crime substitution hypothesis’ is plausible. Therefore, in our recent paper, Dr. Sutton and I set out some ideas that support it as something possibly worthy of further exploration.

As highlighted above, research suggests some young people are spending many hours playing video games or social networking. Research also suggests that video games can be engrossing, addictive and in some cases compulsive. Additionally, research has failed to establish that violent media is either a necessary or sufficient condition for causing crime. Therefore, taking a Routine Activity Approach, it would seem that an increase in video gaming might feasibly lead to a rise in the illicit market for stolen computers and games consoles. However, there might be fewer thieves to supply it if:

• Fewer potential offenders are getting addicted to opiates and other drugs, and/or misusing alcohol out of boredom because they have escaped boredom in the real world by entering the more exciting world of cyberspace to play and interact with others.
• Potential offenders and victims are gaming excessively and/or compulsively checking Facebook and/or other social networking sites.
• The game players and other ‘netizens’ are playing at home so (a) fewer potential offenders on the streets and fewer potential victims, and (b) houses are occupied for longer and so less susceptible to burglary.
• Immersion and gaming prowess and reputation may be sufficient substitutes for the same things in the offline (real) world
• The Internet allows more people to work from home so teleworking may reduce the pool of “available” victims on the street and also ensure fewer homes are empty during the day.

The evidence provided for the ‘crime substitution hypothesis’ in our paper was anecdotal and/or correlational in nature but we would argue that this would provide a fruitful avenue for further research. Such research into ‘crime substitution’ and gaming/social networking might involve: (i) measuring time spent gaming and social networking by groups that empirical research predicts are at greater risk of becoming offenders, (ii) conducting ethnographic studies with young people to gauge whether, and if so to what extent, gaming and social networking are used as a substitute for risky activities in the offline (real) world, and do this in relation to both potential offending and victimization, (iii) examining issues of offline and online peer status and how this may impact on consequent behaviour (including criminal activity), and (iv) further examining the correlation between console and game sales – and any data on playing time and type of games – with the general crime trend over the past 20 years.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Cole, H. & Griffiths, M.D. (2007). Social interactions in Massively Multiplayer Online Role-Playing gamers. CyberPsychology and Behavior, 10, 575-583.

De Freitas, S. & Griffiths, M.D. (2008). The convergence of gaming practices with other media forms: what potential for learning? A review of the literature. Learning, Media and Technology, 33, 11-20.

Griffiths, M.D. (2005). Video games and health. British Medical Journal, 331, 122-123.

Griffiths, M.D. (2005b). The therapeutic value of videogames. In Goldstein J. & Raessens J. (eds.) Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

Griffiths, M.D. (2008). Internet and video-game addiction. In C. Essau (Ed.), Adolescent Addiction: Epidemiology, Assessment and Treatment (pp.231-267).  San Diego: Elselvier.

Griffiths, M.D. (2010). Trends in technological advance: Implications for sedentary behaviour and obesity in screenagers. Education and Health, 28, 35-38.

Griffiths, M.D. & Kuss, D. (2011). Adolescent social networking: Should parents and teachers be worried? Education and Health, 29, 23-25.

Griffiths, M.D. & Sutton, M. (2013). Proposing the Crime Substitution Hypothesis: Exploring the possible causal relationship between excessive adolescent video game playing, social networking and crime reduction. Education and Health, 31, 17-21.

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D.J. & Griffiths, M.D. (2011). Excessive online social networking: Can adolescents become addicted to Facebook? Education and Health, 29. 63-66.

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.

Sutton, M (2010) Routine Activities Theory, the Internet and the 15-Year crime drop. Criminology: The Blog of Mike Sutton. Best Thinking: http://www.bestthinking.com/thinkers/science/social_sciences/sociology/mike-sutton?tab=blog&blogpostid=9634,9634

Care in the (gaming) community: Social responsibility and the videogame industry

In recent years, the problematic use of online videogames has received increased attention not only from the media, but also from psychologists, psychiatrists, mental health organizations and gamers themselves. A number of studies from different cultures are providing evidence that somewhere around 7 to 11% of gamers seem to be having real problems to the point that they are considered pathological gamers. In extreme cases, some gamers are reported to have been playing for 40, 60, and even 90 hours in a single gaming session.

While it may be difficult to distinguish between a healthy and unhealthy usage of online videogames, there is sufficient evidence to describe some excessive gaming as problematic and/or addictive when it pervades and disrupts other aspects of life making it an issue worthy of extensive investigation. In some cases this leads to symptoms commonly experienced by substance addicts, namely salience, mood modification, craving and tolerance. Research suggests that some gamers are struggling to keep their playing habits under control and consequently compromise their academic achievement, real-life relationships, family relationships, physical health, and psychological wellbeing.

Despite a decade of research, there is significant disagreement on whether pathological gaming can be conceptualized as an impulse control disorder and/or a behavioural addiction such as pathological gambling. While acknowledging the potential for some gamers to engage in pathological use, most researchers argue in favour of creating an official diagnosis for pathological gaming. However, others disagree and advise caution about the potential for exaggeration of a real but uncommon problem. As well as the divergence of opinions in the scholarly community, there is insufficient evidence to reach any definitive conclusions or an operational definition of pathological gaming, its diagnosis criteria and prevalence. While the academic debate is likely to continue for a while, it is clear that for a small minority of gamers, pathological gaming leads to negative life consequences.

Against this backdrop, comparable with the cautionary health messages on tobacco and alcohol packaging, warning messages about risk of overuse have recently started to appear on the loading screens of popular online games. For example:

• World of Warcraft – ‘Take everything in moderation (even World of Warcraft)’ and ‘Bring your friends to Azeroth, but don’t forget to go outside of Azeroth with them as well’;
• Final Fantasy XI – ‘Exploring Vana’diel is a thrilling experience. During your time here, you will be able to talk, join, and adventure with many other individuals in an experience that is unique to online games. That being said, we have no desire to see your real life suffer as a consequence. Don’t forget your family, your friends, your school, or your work.’

These and similar warning messages raise the question of why the online videogame industry warns its players not to overuse their product. Does the videogame industry really believe that their products have addictive features that can lead to negative consequences and the functional impairment of gamers’ lives? This leads to the important issue of whether the giving of such messages by online videogame companies means they have done enough to fulfil their social responsibility or do they have they a wider role to play? Furthermore, these warning messages suggest that the online videogame industry knows how high the percentage of over-users is, how much time gamers’ spend playing, and what specific features makes a particular game more engrossing and addictive than others. While they do not directly admit this, by showing these warning messages, they do take some responsibility into their own hands.

Companies in the online video games sector have started to face criticism around the addictive and problematic nature of the use involved with certain online games and their violent content, suggesting that it is a controversial industry. Gaining broader societal acceptance has become a critical factor for companies in controversial industries where failure to meet stakeholders’ societal expectations result in their legitimacy being challenged. Unlike the gambling industry, which has a long history of forced governmental regulation and in which CSR has become a crucial issue, the online videogame industry has, by and large to date, escaped governmental action. However, there are some isolated examples of governmental interventions. For example, China introduced controls to deter people from playing online videogames for longer than three hours, while Thailand’s government banned Grand Theft Auto 4 when a student murdered a taxi driver while trying to recreate a scene from the game ‘to see if it was as easy as in the game’. In addition, the Australian classification board refused the original version of Fallout 3 due to the high level of realistic drug use thus forcing its developer Bethesda Softworks to release a censored version.

In the USA, the sales of ‘Mature’ (M) or ‘Adults Only’ (AO) rated games to minors has been an issue of much concern to public officials, and the Video Games Ratings Enforcement Act introduced to the US House of Representatives requires an ID check for M- and AO-rated game purchases (US Congress, 2006). The majority of game publishers have decided to get controversial games rated by voluntary rating systems. For example, the Entertainment Software Rating Board (ESRB) rates games in the USA and Canada, the British Board of Film Classification (BBFC) in the UK, and the Pan European Game Information (PEGI) in Europe. While the ESRB and PEGI ratings are not legally binding, the BBFC ratings are backed up by the British law, thus making it illegal to sell the game to anyone under the indicated age. Few publishers in the online videogame industry have attempted to develop and sell a game with the strictest ESRB rating of AO. While rating systems are helpful, a study commissioned by the UK games industry found that parents let their children play games with adult or 18+ ratings, because they perceived age ratings as a guide but not as a definite prohibition.

Online videogame developers and publishers need to look into the structural features of the game design, for example, character development, rapid absorption rate, and multi-player features, that make them addictive and/or problematic for some gamers. This undertaking falls mainly on the game developers as they hold the codes for making the games less addictive. For example, long quests can be shortened to minimize the time spent in the game to obtain a certain prized item. Blizzard Entertainment, the makers of World of Warcraft, introduced some down-tuning of hardcore game-play mechanisms that encouraged excessive gaming. Initially, a symbolic and unique in-game title was rewarded to players who progress their character to the maximum level of 80 fastest. However, after several pages of forum debate in which players expressed their concern, an official Blizzard representative announced the removal of the title from the game.

Many games make use of variable ratio reinforcement schedules, which provides a very intense experience, thus increasing the addictiveness of the virtual world. Although, the potentially addictive design features of MMORPGs might not be intentional there is an obligation on the developers to consider ways of limiting harm. One way of doing this can be for developers to make design changes on time limits as many gamers schedule and plan according to the in-game periods of time. For example, long quests could be shortened, the amount of experience points needed to reach the next level could be lowered, spawns could be timed to appear more frequently to give gamers increased chances of receiving specifically wanted items and by speeding the processes of difficult task, gamers will be able to leave the game much earlier after completing their tasks. Implementing these changes to MMORPGs would show that game developers are taking CSR seriously and that they are concerned with more than revenue.

In terms of effective care policies for the gamers, the most observable act until now by the online videogame publishers is the initiation of warning messages. Through these messages, the industry is seemingly addressing CSR in the area of excessive use of videogames, albeit to a rather limited extent. Furthermore, some games (such as WoW) have a parental mode that allows parents to restrict playing time for their children.

Online videogame publishers should make provision for suitable referral services. Presently, they provide neither referral services nor customer care with regard to videogame addiction. Although the time constraints policies applied in China might not be a viable option in Europe, companies can potentially identify from their databases extreme or problematic gamers who are spending an excessive amount of time in the game and offer them contact information for a referral service in their country. Empirical evidence from the gambling industry suggests that similar initiatives and other social-responsibility tools are appreciated by players. There is also recent empirical evidence from the gambling studies field that the setting of time limits helps the most gaming intense players the most. In the context of online gambling, I have suggested that it is not the gaming industry’s responsibility to treat gamblers but it is their responsibility to provide referrals for problem gamblers to specialist helping agencies. I have argued that it is better for the industry to refer their problem customers to online help that offers a high degree of anonymity (as this is preferred by online gamblers). This is an important finding for the online videogame industry to take on board, as it seems that it is not currently taken into consideration in their CSR practices. Online videogame companies need to take social responsibility for the extreme and problematic usage of their products. The proportion of gamers who develop problems and/or become addicts may stay roughly constant but as online videogames get better and better, and increasing numbers of people discover them, the number of addicts is most probably going to rise.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input: Dr. Shumaila Yousafzai and Dr. Zaheer Hussain

Further reading

Auer, M., & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, DOI 10.1007/s10899-012-9332-y.

Cai, Y., Jo, H., & Pan, C. (2012). Doing well while doing bad? CSR in controversial industry sectors. Journal of Business Ethics, 108, 467–480.

Ferguson, C. J., Coulson, M., & Barnett, J. (2011). A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. Journal of Psychiatric Research, 45, 1573–1578.

Griffiths, M.D. (2010). Age ratings on video games: Are the effective? Education and Health, 28, 65-67.

Griffiths, M.D., & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39, 47-53.

Griffiths. M.D., Wood, R.T.A. (2008). Responsible gaming and best practice: How can academics help? Casino and Gaming International, 4(1), 107–112.

Griffiths, M.D., Wood, R.T.A. & Parke, J. (2009). Social responsibility tools in online gambling: A survey of attitudes and behaviour among Internet gamblers. CyberPsychology and Behavior, 12, 413-421.

Griffiths, M.D., Wood, R.T.A., Parke, J. & Parke, A. (2007). Gaming research and best practice: Gaming industry, social responsibility and academia. Casino and Gaming International, 3(3), 97-103.

Hussain, Z., Griffiths, M.D. & Baguley, T. (2012).Online gaming addiction: classification, prediction and associated risk factors. Addiction Research & Theory 20(5), 359-371.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Haagsma, M.C.^, Delfabbro, P.H.,Gradisar, M.S.& Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

Porter, G., Starcevic, V., Berle, D., & Fenech , P. (2010). Recognizing problem video game use. Australia Newzealad Journal of Psychiatry, 44(2),120 –128.

Van Rooij, A., Meerkerk, G., Schoenmakers, T., Griffiths, M., & van de Mheen, D. (2010). Video game addiction and social responsibility. Addiction Research & Theory, 18(5): 489-493.

Yousafzai, S.Y., Hussain, Z. & Griffiths, M.D. (2013). Social responsibility in online videogaming: What should the videogame industry do? Addiction Research and Theory, DOI: 10.3109/16066359.2013.812203

Screen play ideas: A speculative look at trends in video game addiction

Gaming addiction has become a topic of increasing research interest. Over the last decade there has been a significant increase in the number of scientific studies examining various aspects of video game addiction. This has resulted in a wide-ranging selection of review papers focusing on different aspects of the topic. These include general literature reviews of video game addiction, reviews of online (as opposed to offline) gaming addiction, reviews of the main methodological issues in studying video game addiction, reviews of structural characteristics and their relationship with video game addiction, reviews of video game addiction treatment, reviews of video game addiction and co-morbidity/convergence with other addictions such as gambling addiction and Internet addiction, and miscellaneous review papers on very specific aspects of video game addictions such as social responsibility, screening instruments, or reviews refuting that video game addiction even exists.

Furthermore, the amount and the quality of research in the gaming addiction field has progressed much over the last decade but is still in its infancy compared to other more established behavioural addictions, such as pathological gambling. Today’s blog briefly provides a considered (and somewhat speculative) examination of what might happen in the gaming addiction field from a number of different standpoints (e.g., methodological, conceptual, technological). These are taken from a paper I recently published in Current Psychiatry Reviews with Dr. Daniel King (University of Adelaide, Australia) and Daria Kuss (Nottingham Trent University, UK). These trends were loosely modeled on a 2011 paper I wrote on the technological trends in gambling and published in Casino and Gaming International.

• There is likely to be an even bigger increase in empirical research into problematic video game playing and video game addiction. This will of course be dependent on both appropriate funding streams and/or whether gaming addiction ends up being included in future psychiatric disorder classifications (e.g., Diagnostic and Statistical Manual, International Classification of Diseases, etc.). Future research is likely to include more epidemiological and/or general population data on media use, leading to better insights into the onset and course of problematic video game play and addiction.

• Given the many different screening instruments that have been developed over the last decade, there is likely to be a refinement of video game addiction measures and greater consensus on its conceptualization, either as a single disorder and/or incorporated into other known disorders (e.g., impulse control disorder). This is also likely to lead to improved assessment tools based on such conceptualization(s).

• Measures of gaming use and subsequent behaviour are likely to diversify in terms of media use, including social networking sites (SNS) and associated Internet resources. Already, games such as Call of Duty and Battlefield 3 are being released with their own SNS (e.g., COD Elite) that track player behaviour and provide feedback to players as to how to improve their game (thus functionally reinforcing video game play and thus have implications for excessive and/or potentially addictive play).

• Given the pressure on media enterprises to ‘monetize’ their business and look for different revenue streams, there is likely to be even greater media convergence between gaming and other more profit-making activities such as gambling. Given the well established addictive potential of gambling, this may also have implications for the incidence of video game addiction.

• Gaming on the move is likely to be a big growth area that may have implications for excessive gaming via ‘convenience’ hardware such as handheld gaming consoles, PDA devices, mobile phones, tablet computers, and MP3 players.

• Given the fact that the Internet is gender-neutral, there is likely to be increasing feminization of gaming where increasing numbers of females not only engage in the playing of online games, but also develop problems as a result. Casual gaming online is already popular among females. However, the biggest difference between male and female gaming is likely to be content-based (e.g., males may prefer competitive type gaming experiences whereas females may prefer co-operative type gaming experiences).

• Given the increasing number of research teams in the gambling field being given direct access to gambling companies behavioural tracking data, there is likely to be an increasing number of such collaborations in the gaming studies field.

• Given the increased importance of additional research into the structural and situational characteristics of consumptive behaviours (e.g., smoking nicotine, drinking alcohol, gambling, etc.), it is likely that research on design features within games and their psychological impact (including potential addiction) will increase as well. Such research has already begun (including quite a few studies by our gaming research unit).

• As the diagnosis of video game addiction becomes more legitimate in psychiatric and medical circles, it will lead to better randomized control trials on interventions for problematic video game play than the ones already carried out. There is also likely to be an increase in the online medium itself being used as a treatment channel. The reasons that people like to engage in some online leisure activities (i.e., the fact that the online environment is non-face-to-face, convenient, accessible, affordable, anonymous, non-threatening, non-alienating, non-stigmatizing, etc.) may also be the very same reasons why people would want to seek advice, help and treatment online rather than in face-to-face situations.

Based on our review paper there are several noticeable trends that can be drawn from our recent reviews of problematic video game play and video game addiction.

• There has been a significant increase in empirical research decade by decade since the early 1980s.

• There has been a noticeable (and arguably strategic) shift in researching the mode of video game play. In the 1980s, research mainly concerned ‘pay-to-play’ arcade video games. In the 1990s, research mainly concerned stand alone (offline) video games played at home on consoles, PCs or handheld devices. In the 2000s, research mainly concerned online massively multiplayer video games.

• There has been a noticeable shift in how data are collected. Up until the early 2000s, data about video game behaviour was typically collected face-to-face, whereas contemporary studies collect data online, strategically targeting online forums where gamers are known to (virtually) congregate. These samples are typically self-selecting and (by default) unrepresentative of the general population. Therefore, generalization is almost always one of the methodological shortcomings of this data collection approach.

• Survey study sample sizes have generally increased. In the 1980s and 1990s, sample sizes were typically in the low hundreds. In the 2000s, sample sizes in their thousands – even if unrepresentative – are not uncommon.

• There has been a diversification in the way data are collected including experiments, physiological investigations, secondary analysis of existing data (such as that collected from online forums), and behavioural tracking studies.

• There has been increased research on adult (i.e., non-child and non-adolescent) samples reflecting the fact that the demographics of gaming have changed.

• There has been increasing sophistication in relation to issues concerning assessment and measurement of problematic video game play and video game addiction. In the last few years, instruments have been developed that have more robust psychometric properties in terms of reliability and validity. However, there are still some concerns as many of the most widely used screening instruments were adapted from adult screens and much of the video game literature has examined children and adolescents. In other papers I have co-written with Dr. King, we have asserted that to enable future advances in the development and testing of interventions for video game-related problems, there must be some consensus among clinicians and researchers as to the precise classification of these problems. (In fact, we’ve just had a major review paper accepted on assessing video game addiction in Clinical Psychology Review which I examined in a previous blog).

Clearly, there exist a number of gaps in current understanding of problematic video game play and video game addiction. There is a need for epidemiological research to determine the incidence and prevalence of clinically significant problems associated with video game play in the broader population. There are too few clinical studies that describe the unique features and symptoms of problematic video game play and/or video game addiction. While the current empirical base is relatively small, gaming addiction has become a more mainstream area for psychological and psychiatric research and is likely to become an area of significant importance given the widespread popularity of gaming.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input: Daria Kuss and Daniel King

Further reading

Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.

Griffiths, M.D. (2011). Technological trends and the psychosocial impact on gambling. Casino and Gaming International, 7(1), 77-80.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2009). The psychological study of video game players: Methodological challenges and practical advice. International Journal of Mental Health and Addiction, 7, 555-562.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The role of structural characteristics in problem video game playing: A review. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. Located at: http://www.cyberpsychology.eu/view.php?cisloclanku=2010041401&article=6.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Cognitive behavioural therapy for problematic video game players: Conceptual considerations and practice issues. Journal of CyberTherapy and Rehabilitstion, 3, 261-273.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

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: In Session, 68, 1185-1195.

King, D.L., Haagsma, M.C.^, Delfabbro, P.H.,Gradisar, M.S. &^, Griffiths, M.D. (2013). Psychometric assessment of pathological video-gaming: A systematic review. Clinical Psychology Review, 33, 331-342.

Scaling up: A brief look at the latest tool to assess addictive gaming

To date, there has been a lack of agreement among researchers as to the precise name and definition of video game addiction (both online and offline). However, there is a general consensus that excessive gaming can lead to a wide range of physical and psychological problems, and therefore necessary to explore the nature and the scale of the phenomenon. In doing so, it is important to use psychometrically validated measurement tools. Unfortunately, there is lack of these in the literature so far. Along with some colleagues (led by Dr. Daniel King), we recently published a paper examining all the instruments that have been used to assess problematic video gaming in the journal Clinical Psychology Review.

Our paper noted that pathological video-gaming, or its proposed DSM-V classification of “Internet Use Disorder”, is of increasing interest to scholars and practitioners in allied health disciplines. Our systematic review was designed to evaluate the standards in pathological video-gaming instrumentation and guidelines for sound psychometric assessment. We assessed a total of 63 quantitative studies, including eighteen instruments (representing 58,415 participants). Our findings indicated that the instruments were generally characterized as inconsistent. The strengths of available measures included: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, the key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggested that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict.

Most of the tools in current use have been modified from other questionnaires without their reliability and validity being tested. This includes those based on internet addiction (e.g., Kimberley Young’s Internet Addiction Test), pathological gambling (using the DSM–IV criteria), or behavioural addictions. An additional problem is that many of the measures focus exclusively on Massively Multiplayer Online Role Playing Game (MMORPG) users. In order to cover the whole range of online gamers, I recently helped co-develop an empirically based questionnaire consisting of 18 items called the Problematic Online Gaming Questionnaire (POGQ) that we published in the journal PLoS ONE.

In a recent 2011 study, some of my Hungarian colleagues (led by Dr. Koronczai) claimed in the journal Cyberpsychology, Behavior and Social Networking that a suitable measure should fit the following six criteria. It should have: (i) comprehensiveness (i.e., examining more, possibly all, aspects of problematic online gaming); (ii) brevity (in order to assess the more impulsive population as well and to facilitate incorporation into time-limited surveys); (iii) reliability and validity for different methods of data collection (e.g., online, paper-and-pencil self-rating, face-to-face); (iv) reliability and validity for different age groups (e.g., adolescents and adults); (v) cross-cultural reliability and validity; (vi) been validated on clinical samples. The measure should also serve as a basis for defining cutoff scores for dependence.

The POGQ is a short comprehensive measure and therefore fits to the first two requirements. It was also found to be a psychometrically adequate measure in a large convenience sample of adult online gamers. However, there is great need for a measure that is also suitable for survey type research in an offline data collection setting, and is reliable and valid for adolescents. Therefore, we modified the original POGQ to a 12-item version and applied it to an offline adolescent sample using pen-and-pencil data collection method (and published the findings in the journal Cyberpsychology, Behavior and Social Networking). This way both the third and the fourth points of the six criteria above were fulfilled.

The aim of or most recent study was twofold. The first goal was to explore the psychometric properties of the POGQ on a nationally representative adolescent sample as until recently it had only been used on adult gamer samples. The second goal was to assess the prevalence of problematic online gaming in a nationwide adolescent sample, as there have been only two nationally representative studies carried out on adolescents in the US and Germany.

The results of or study showed that the 12-item POGQ-SF had appropriate psychometric properties according to the statistical analysis performed on a nationally representative sample of adolescents. The analysis showed that 8.2% of gamers (4.6% of the whole sample) belonged to the at-risk group. We also found an additional 13.3% of adolescents (23.9% of gamers) showed symptoms of problematic online gaming above the average. Gamers belonging to the at-risk class were more likely to be male, more likely to play for five or more hours a day, have lower grade point average, have lower self-esteem, and higher depression score than gamers belonging to the other two classes. All these results are in line with findings of other studies confirming the validity of the measurement tool.

Despite the robustness of the study, an important limitation was that it was only carried out among Hungarian adolescents. For generalizability it must be applied and psychometrically tested on cross-cultural samples as well (see the aforementioned Criterion 5). It is also a future goal to confirm the POGQ on clinical samples (Criterion 6). This would allow all the six criteria requirements presented in the introduction to be met. The current POGQ is both short (Criterion 2) and comprehensive (Criterion 1), and assesses problematic online gaming in different age groups (Criterion 4) with different data collection methods (Criterion 3). We hope that the POGQ will facilitate future research and will serve as an adequate tool for assessing problematic online gaming.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

Gentile, D. (2009). Pathological video-game use among youth ages 8 to 18: A national study. Psychological Science, 20, 594-602.

Gentile, D.A., Choo, H., Liau, A., et al. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127, E319-E329.

King, D.L., Haagsma, M.C.^, Delfabbro, P.H.,Gradisar, M.S.^, Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., et al. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in children and adolescents: A review of empirical reearch. Journal of Behavioral Addictions, 1, 3-22.

Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, doi:10.1089/cyber.2012.0484.

Rehbein, F., Kleimann, M, & Mossle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. CyberPsychology, Behavior and Social Networking, 13, 269–277.

Tech’s appeal: Is there a relationship between addiction to video games and slot machines?

Back in 1987, I began my PhD on slot machine addiction, and one thing that I began to notice as I spent the first few hours of (100s of hours) doing observational research in amusement arcades that there were many similarities between arcade slot machines and arcade video game machines. It wasn’t until 1991 that I finally did a comparative analysis of slot machine gambling and video game playing and published my observations in the Journal of Adolescence. In the intervening years I have published many papers examining the commonalities and similarities between these two behaviours and it wouldn’t surprise me if I am still writing about these issue in many years to come.

My initial insights into the existence of video game addiction arose out of the research I had been doing on slot machine addiction. Both slot machines and video game machines may be considered under the generic label of “amusement machines”. The main difference between the playing of video games and the playing of slot machines are that arcade video games are typically played to accumulate as many points as possible whereas slot machines are played (i.e., gambled upon) to accumulate money. In my 1991 paper, I (somewhat paradoxically) claimed that playing an arcade video game could be considered as a non-financial form of gambling.

Both types of machine require insertion of a coin to play, although the playing time on a slot machine is usually much less than on a video game machine if starting with the same amount of money. This is because on video games the outcome is almost solely due to skill, whereas on slot machines the outcome is much more likely to be a product of chance. However, the general playing philosophy of both slot machine players and video game players is to stay on the machine for as long as possible using the least amount of money. I have also argued that regular slot machine players play with money rather than for it, and that winning money is a means to an end (i.e., to stay on the machine as long as possible). This is exactly what arcade video game players do too.

Besides the generic labeling, their geographical juxtaposition, and the philosophy for playing, it could be argued that on both a psychological and behavioural level, slot machine gambling and video game playing share many similarities (e.g., similar demographic differences such as age and gender breakdown, similar reinforcement schedules, similar potential for “near miss” opportunities, similar structural characteristics involving the use of light and sound effects, similarities in skill perception, similarities in the effects of excessive play, etc.). The most probable reason the two forms have rarely been seen as conceptually similar is because video game playing does not involve the winning of money (or something of financial value) and therefore cannot be classed as a form of gambling.

However, the next generation of slot machines is starting to use video game graphics and technology. While many of these relate to traditional gambling games (e.g., roulette, poker, blackjack, etc.) there are plans for developing video gambling games in which people would win money based on their game scores. This obviously gives an idea of the direction that slot machines and the gaming industry are heading.

Furthermore, there are a growing number of researchers who suggest that video games share some common ground with slot machines including the potential for dependency. On 1995, Dr Sue Fisher and myself edited a special issue of the Journal of Gambling Studies and wrote a paper examining trends in slot machine gambling. We pointed out that arcade video games and slot machines shared some important structural characteristics, these being:

• The requirement of response to stimuli that are predictable and governed by the software loop.
• The requirement of total concentration and hand–eye coordination.
• Rapid span of play negotiable to some extent by the skill of the player (more marked in video games).
• The provision of aural and visual rewards for a winning move (e.g., flashing lights, electronic jingles).
• The provision of an incremental reward for a winning move (points or money) that reinforces “correct” behaviour.
• Digitally displayed scores of “correct behaviour” (in the form of points or money accumulated).
• The opportunity for peer group attention and approval through com- petition.

As with excessive slot machine playing, excessive video game playing partly comes about by the partial reinforcement effect. This is a critical psychological ingredient of video game addiction whereby the reinforcement is intermittent – that is, people keep responding in the absence of reinforcement hoping that another reward is just around the corner. Knowledge about the partial reinforcement effect gives the video game designer an edge in designing appealing games. Magnitude of reinforcement is also important. Large rewards lead to fast responding and greater resistance to extinction – in short to more “addiction.” Instant reinforcement is also satisfying.

Video games rely on multiple reinforcements (i.e., what I call the “kitchen sink” approach) in that different features might be differently rewarding to different people. Success on video games comes from a variety of sources and the reinforcement might be intrinsic (e.g., improving a personal high score, beating a friend’s high score, putting a name on the “hall of fame,” mastering the machine) or extrinsic (e.g., peer admiration). As early as the 1980s, Dr. Thomas Malone reported that video game engagement is positively correlated to (i) a presence or absence of goals, (ii) the availability of automatic computer scores, (iii) the presence of audio effects, (iv) the random quality of the games, and (v) the degree to which rapid reaction times enhance game scores.

In 2007, Dr Jonathan Parke (Salford University, UK) and I developed a new taxonomy of structural characteristics related to gambling, listing all the known structural characteristics that have been shown to influence gambling behaviour in some way. All the 60+ structural characteristics were grouped into one of six types of characteristic:

• Speed and frequency characteristics: Factors relating to the frequency, duration and expediency of the game or reward.
• Playability characteristics: Factors that make gambling fun, interaction and/or engaging.
• Payment characteristics: Factors that relate to how one pays to gamble
• Reward characteristics: Factors relating to how one receives financial rewards or winnings.
• Educational characteristics: Factors that educate, protect, or provide information to players.
• Ambient characteristics: Factors that may influence the immediate situation of the game or may contribute to other factors already mentioned (e.g., the use of colour and sound).

Using this typology, Dr Parke and I argued that future research and policy initiatives may be to focus on regulating structural factors relating to payment (spending) and player awareness/education and focus less on structural factors relating to playability (which may also include reward, ambient, and speed characteristics). In this way, slot machines can continue to be fun, exciting, and play inducing, but with the eventual aim of minimizing harm.

It wasn’t until 2010 that I – along with Dr Daniel King and Dr Paul Delfabbro (both at the University of Adelaide, Australia) – developed a separate taxonomy of structural characteristics related to video game playing (published in the International Journal of Mental health and Addiction). We used some earlier empirical work that I had done with Dr Richard Wood (GamRes Ltd, Canada) back in 2004 and published in the journal CyberPsychology and Behavior. We devised a list of structural features by (a) playing a variety of video games, (b) examining and comparing known gambling structural characteristics, (c) discussing these features with players of video games, and (d) examining relevant research in the area of video game design. Our framework included the following characteristics:

• Sound, including sound effects, speaking characters and background music.
• Graphics, including high-quality realistic or cartoon-style graphics and full motion video (FMV).
• Background and setting, including whether the game is based on a story, film, or television program, and the use of realistic or fantasy settings.
• Duration of game, referring to how long the game usually takes to complete.
• Rate of play, referring to how quickly the player “absorbs” or “gets into” the game. & Advancement rate, referring to how quickly the game play advances.
• Use of humour in the game.
• Control options, referring to what the player can control in the game (including sound, graphics, and skill settings, choice of control methods, and physical feedback). &
• Game dynamics, including exploring new areas, elements of surprise, fulfilling a quest, skill development, AI interactions, collecting things, avoiding things, surviving against the odds, shooting, different ending options, different modes of transport, solving puzzles, beating times, cheats/Easter eggs, solving time limited problems, building environments, mapping, and linear/non-linear game format.
• Winning and losing features, referring to the potential to gain or lose points, finding bonuses, having to start level again, and ability to save regularly.
• Character development, referring to character development over time and character customization options.
• Brand assurance, referring to brand loyalty and/or celebrity endorsement.
• Multiplayer features, referring to various multi-player options, communication methods, building alliances, and beating other players.

Using this paper, and the gambling structural characteristics taxonomy, we developed our new video game structural characteristics taxonomy comprising five types of feature. These were: (a)

• Social features (i.e., social aspects of video game playing)
• Manipulation and control features (i.e., the role of user input in influencing in-game outcomes)
• Narrative and identity features (e.g., the role of character creation and interactive storytelling)
• Reward and punishment features (i.e., the ways in which players win and lose in video games)
• Presentation features (e.g., the visual and auditory presentation of video games).

Since developing the taxonomy, we have started to test it out empirically. Dr. King, Dr. Delfabbro and myself recently published a study investigating our structural characteristic taxonomy among 421 video game players (aged between 14 and 57 years). Our results showed that the reward and punishment features, such as earning points, finding rare game items, and fast loading times, were rated among the most enjoyable and important aspects of video game playing. There was some evidence that certain structural characteristics were stronger predictors of problematic involvement in video games than factors such as gender, age, and time spent playing. This included the use of adult content in the game, earning points, getting 100% in the game, and mastering the game. Our latest research supports the notion that some structural characteristics in video games may play a significant role in influencing problem video game playing behaviour.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Fisher, S.E., & Griffiths, M.D. (1995). Current trends in slot machine gambling: Research and policy issues. Journal of Gambling Studies, 11, 239-247.

Griffiths, M.D. (1991). The observational analysis of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1991). Amusement machine playing in childhood and adolescence: A comparative analysis of video games and fruit machines. Journal of Adolescence, 14, 53-73.

Griffiths, M.D. (1995). Adolescent gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2005). The relationship between gambling and videogame playing: A response to Johansson and Gotestam. Psychological Reports, 96, 644-646.

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling.  In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

Griffiths, M.D. (2011).  A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

King, D.L., Delfabbro, P.H., Derevensky, J. & Griffiths, M.D. (2012). The classification of video games with gambling themes and content: An Australian perspective. International Gambling Studies, in press.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2011). The role of structural characteristics in problematic video game play: An empirical study. International Journal of Mental Health and Addiction, 9, 320-333.

Malone, T.W. (1981). Toward a theory of intrinsically motivating instruction. Cognitive Science, 4, 333–369.