One of things I am very proud of in my academic career is the coining of the term ‘technological addiction’ back in 1995 (an umbrella term that I invented to describe a number of different person-machine addictions including slot machine addictions, video game addiction, television addiction, etc.). I’m also proud of coining the term ‘aca-media’ (relating to academics like myself that use the media to disseminate our research). A neologism (i.e., the name for a newly coined term) is often (according to Wikipedia) directly attributable to a specific event, person, publication, or period.
In the 1980s and early 1990s, there seemed to be a real upsurge is the naming of ‘new syndromes’ in the medical literature including many relating to excessive use of technology (such as ‘Space Invader’s Wrist’) and other leisure activities (such as ‘Cuber’s Thumb’ relating to excessive use of the Rubik’s Cube) – both of which made their appearance in 1981 issues of the New England Journal of Medicine. Other videogame medical complaints include ‘Pseudovideoma’ (in a 1984 issue of the Journal of Hand Surgery), ‘Pac-Man Phalanx’ (in a 1983 issue of Arthritis and Rheumatism) and ‘Joystick Digit’ (in a 1987 issue of the Journal of the American Medical Association). Another videogame-related medical complaint (in this case an infection), was reported in a 1987 issue of the Western Journal of Medicine by Dr. G.B. Soe and colleagues:
“We wish to focus WJM readers’ attention on another complication associated with video games-one that originally presented as an “infected spider bite. A 17-year-old right-handed boy noted progressive swelling and redness of his left hand seven days before admission. Two days before admission he was given penicillin intramuscularly and oral cephalexin to take at home. The swelling did not subside and the hand became very painful, so he came to the medical center for treatment. On admission his mother reported that she had seen many spiders around the house with a violin pattern on their backs, and that her son had probably been bitten by a spider…After seven days of parenteral antibiotic therapy, the edema, erythema and fever had disappeared and the patient was discharged home. Further questioning revealed that the young man was spending almost all of his time playing his favorite video game, which involved a fighting kung fu character. The patient used his left hand in manipulating a ball-shaped joystick to move the figure up, down, left and right, and his right in operating buttons to kick and jab. Extensive use of the joystick resulted in blisters on his left palm. He rubbed the blisters off, and an infection resulted that progressed to abscess formation. Neuromuscular complications of video games (‘pseudovideoma’, ‘Pac-Man phalanx’, ‘firing-finger syndrome’ and ‘Space Invaders wrist’) have been reported, as well as video game-induced seizures, but we have not come across any reports of an infectious complication of video games. Perhaps video game players should wear gloves to protect their palms, similar to ones worn by golfers and baseball players, who also need to get a firm grip on their respective sticks”.
Another one that I’d never heard of is ‘Nurd Knuckles’ coined by Dr. J.B. Martin in the Canadian Medical Association Journal in 1982:
“I wish to describe a case of painful knuckles associated with the use and manipulation of a new, allegedly therapeutic product, a Nurd. A Nurd is a head 10 cm across with a smiling face and large ears, reminiscent of the character Yoda of ‘Star Wars’. It is made of malleable material that can be stretched, twisted or deformed in any direction, yet with release of tension quickly resumes its original shape without a trace of distortion. A 32-year-old public school teacher presented with painful knuckles of his right hand. His students, perhaps feeling that their teacher was under increased stress during the marking of exams, had given him a Nurd for Christmas, and during a particularly trying day he had found occasion to use it. He repeatedly stretched its ears and twisted its neck without ill effect; however, on punching it he suffered sharp pain of his fourth and fifth metacarpophalangeal joints. On examination the joints were found to be reddened, with point tenderness over the fifth metacarpal head; there was no evidence of deformity. He was advised to stop beating his Nurd, and the pain subsided. While the Nurd is very plastic, yielding to the linear tension of stretching and twisting, it is very resistant to compression. Punching a Nurd does not cause the surface to give way, and, since the force of the blow is returned to the fist, it is conceivable that a fracture might result. Therefore, although stretching and twisting Nurds does not cause any harm, users should be cautioned against punching their Nurd. The Nurd is advertised as being a ‘punchable, stretchable, pushable and likeable alternative to tension, migraine headaches, drug abuse, alcoholism and manic depression’, but these claims are unsubstantiated. A MEDLINE search of the medical literature shows that no retrospective or prospective case control studies or controlled double blind crossover studies have been undertaken. Before the clinical efficacy of the Nurd can be taken seriously in the treatment of this broad spectrum of disease, full clinical trials must be completed. Subjects entering into trials must, however, be duly informed of the hazards of punching Nurds”.
Another one that caught my attention was a new affliction (‘Breaker’s Neck’) caused by the craze of ‘break dancing’ reported by Dr. Bertha Ramirez and her colleagues in a 1984 issue of the Journal of the American Medical Association. (The reason why I say it caught my eye is that I am currently involved in some research on ‘dancing addiction’ with some of my Hungarian colleagues and we have just had a new paper accepted in the journal PLoS ONE concerning the development of our ‘Dancing Motives Inventory’ – see ‘Further Reading’ below).
“To be added to the rapidly growing list of socially acquired injuries, we report a case of traumatic cervical subluxation caused by a new dance technique. This technique, labeled ‘breaking’ by its devotees, involves a modified head stand, in which the dancer, using his arms and hands for balance, spins rapidly on his head, neck, or shoulders to the rhythm of disco music. He then lowers his body to the floor and performs a series of rotational motions using his arms as a fulcrum…A 15-year-old boy was seen in our pediatric emergency room complaining that, on awakening two days previously, he felt a ‘snap’ in his neck, followed by persistent neck stiffness. He reported having ‘danced on his head’ the night prior to this incident. On physical examination, his head was tilted to the left with an inability to flex”.
Engaging in excessive sporting activity has given rise to a number of medical syndromes. One such consequence is ‘Rower’s Rump’ reported by Drs. K Tomecki and J. Mikesell in a 1987 issue of the Journal of the American Academy of Dermatology. In a previous blog I examined addiction to cycling. In the 1980s there were many medical complaints reported as a result of excessive cycling. One such complaint (given the name of ‘Bicycling nipples’) was highlighted by Dr. B. Powell in a 1983 issue of the Journal of the American Medical Association:
“Bicyclists are likely to suffer from a number of maladies, including dysuria, numb penises, and more. During cool or cold weather, another problem, bicyclist’s nipples, may occur. This condition is similar to jogger’s nipples, but it is primarily a thermal injury instead of an irritation secondary to friction, as with the jogger’s complaint. Often the rider is out in the cold weather for some time, and his or her undershirt, jersey, and jacket can become moist from perspiration. Evaporation and the chill of the wind lower the temperature of the nipples. They get downright cold, and they hurt. The pain continues after the ride is over. Indeed, it can continue for several days. The nipples are sore, sensitive to both temperature change and touch”.
After reading this I found out that Dr. Fred Levit had reported a case of ‘Jogger’s Nipples’ in a 1977 issue of the New England Journal of Medicine. All of these related nipple conditions are all examples of fissure of the nipple as they are all caused by friction resulting in soreness, dryness or irritation to, or bleeding of, one or both nipples. The Wikipedia entry also notes that “the condition is also experienced by women who breastfeed, and by surfers who do not wear rash guards”. The article also noted that:
“Jogger’s nipple is caused by friction from the repeated rubbing of a t-shirt or other upper body clothing against the nipples during a prolonged period of exercise. The condition is suffered mainly by runners. Long-distance runners are especially prone, because they are exposed to the friction on the nipple for the greatest period of time. However, it is not only suffered by athletes; the inside of a badge, a logo on normal items of clothing, or breastfeeding can also cause the friction which results in this condition”.
Outside of the leisure sphere, there were two case study reports of ‘Diaper Doer’s Hand’ in a 1987 issue of the journal Clinical Rehabilitation by Dr. J.L. Cosgrove and colleagues:
“Three cases of stenosing tenosynovitis occurred three to six months postpartum. Childcare activities aggravated the symptoms of pain and swelling in both patients. In two cases, a specific method of carrying the child was implicated as the mechanism of injury. Although there was no evidence of generalized inflammatory arthritis, all patients had very low positive titres of anti-nuclear antibodies. While it is likely that tenosynovitis was caused by mechanical factors, the possibility of increased susceptibility to inflammatory disease in the postpartum period cannot be discounted. The patients were successfully treated with a low temperature plastic splint, superficial heat and gentle mobilization”.
All of these new syndromes lead to why I put this article together in the first place. I found this letter in the British Medical Journal by Dr. E.P. Hoare entitled ‘New Syndrome Syndrome’ that I found both funny and poignant:
“Your readers will be familiar with tennis elbow, brazier’s ague, and soap packer’s jig not to mention Achilles’ heel. More recently we have heard of Space Invader’s wrist, jogger’s nipples, and the ultimate futility of Cuber’s thumb. May I point out another occupational disease which I have noticed among patrons of the reading room medical journal correspondence column reader’s neck or, more succinctly, the new syndrome syndrome. Symptoms usually begin with muscular contraction of the eyebrows, hyperventilation, and involuntary utterances, which in severe cases can lead to coprolalia. These may be followed by drowsiness, disorientation, hysterical amblyopia, and double vision (of the deja vu variety). If untreated the condition can result in a chronic pain in the neck. Treatment is 200 ml of gin and tonic stat by mouth and complete rest; music can also be helpful. The long-term prognosis is poor, however, unless journal editors can be persuaded to ban further reports of occupational afflictions or at least print a health warning at the head of their correspondence columns”.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Behr, J.T. (1984). Pseudovideoma. Journal of Hand Surgery, 9(4), 613.
Cosgrove, J. L., Welch, D. A., Richardson, G. S., & Nicholas, J. J. (1987). Diaper doer’s hand: stenosing tenosynovitis in the postpartum period. Clinical Rehabilitation, 1(3), 219-223.
Gibofsky, A. (1983). Pac‐Man phalanx. Arthritis and Rheumatism, 26(1), 120.
Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.
Griffiths, M.D. (1995). Pop psychology and “aca-media”: A reply to Mitchell. The Psychologist: Bulletin of the British Psychological Society, 8, 537-538.
Griffiths, M.D. (2001). A moral obligation in aca-media? The Psychologist: Bulletin of the British Psychological Society, 14, 460.
Hite, P. R., Greene, K. A., Levy, D. I., & Jackimczyk, K. (1993). Injuries resulting from bungee-cord jumping. Annals of emergency medicine, 22(6), 1060-1063.
Hoare, E.P. (1982). Points: New syndrome syndrome. British Medical Journal, 285(6352), 1429.
Levit, F. (1977). Jogger’s nipples. New England Journal of Medicine, 297(20), 1127.
Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, in press.
Martyn, J. B. (1983). Nurd knuckles. Canadian Medical Association Journal, 129(3), 228.
McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.
Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.
Powell, B. (1983). Bicyclist’s nipples. Journal of the American Medical Association, 249(18), 2457-2457.
Ramirez, B., Masella, P. A., Fiscina, B., Lala, V. R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.
Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.
Tomecki, K. J., & Mikesell, J. F. (1987). Rower’s rump. Journal of the American Academy of Dermatology, 16(4), 890-891.
Torre, P. R., Williams, G. G., Blackwell, T., & Davis, C. P. (1993). Bungee jumper’s foot drop peroneal nerve palsy caused by bungee cord jumping. Annals of emergency medicine, 22(11), 1766-1767.
Waugh, D. (1981). Cuber’s thumb. New England Journal of Medicine, 305, 768.
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
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.