(L) Internet Use Gaming Disorder Included in New DSM-5 (2013)

Internet Use Gaming Disorder Included in New DSM-5

Although compulsive Internet gaming is nothing new, this is the first time the American Psychiatric Association has recommended the disorder for further study.

Teen Suicide

MONDAY, May 20, 2013 — At the height of his 20 year addiction to video games, Ryan Van Cleave recalls a three year period in which his every thought was dominated by an alternate universe known as “The World of Warcraft,” a popular online game in which multiple players role play and control characters in a huge virtual world while battling monsters and each other. The married college professor and father of two from Sarasota, Fla., says that while others were living normal lives, he was living in this alternate world where he would mull over high-powered weapon trades, fret about battleground honors he needs to earn, and concern himself with his inventory of characters.

“I was consumed by this never-ending, breathtaking, virtual universe,” said Van Cleave, author of Unplugged: My Journey Into the Dark World of Video Gaming (2010). “It was as if an unseen digital umbilical cord was keeping me eternally wired to the game that demands my every waking moment. There was a constant yearning. When I wasn’t gaming, it felt like a part of me was missing. There was a lack in my life. To play was to remove that lack, that sense of wrongness.“

Psychotherapy Used on Web AddictsVan Cleave gave up playing games, cold turkey, in 2007 and has since made it his mission to make the public aware of the dangers of gaming through his writings and lectures. He is glad to see that “Internet use gaming disorder” has finally been acknowledge as a disorder in the new “DSM-5” (“Diagnostic and Statistical Manual of Mental Disorders,” May 2013), which was unveiled in San Francisco at the American Psychiatric Association (APA) annual meeting this week.There is still some dispute as to whether gaming and compulsive use of the Internet is a mental disorder unto itself or is related to a different form of addiction. Internet use gaming disorder has been included in DSM-5 as a condition “recommended for further study” and still lacks the kind of uniform diagnostic criteria you might find with alcoholism and gambling, but Van Cleave said he doesn’t need a psychiatric manual to tell him video gaming can be a serious problem for some.

“I know it’s real,” he said. “Whether you call it ‘video game addiction’ or ‘video game abuse’ or whatever you choose, I know it has a devastating power over many gamers. It’s hard to say exactly when I was ‘addicted’ because I had a long-standing unhealthy relationship with video games — two decades or so. But for sure, the last three years of my gaming — where I was playing World of Warcraft exclusively for up to 50 hours a week — counts [as addiction].”

“That’s not to say everyone who games is an addict, nor am I saying video games are evil,” Van Cleave added. “Playing a video game for 45 minutes after school or work is fine. Playing until 4:30 in the morning is less so.”

Videos Games Designed for Addiction

Russell Hyken, Ph.D., Ed.S, is a psychotherapist and educational diagnostician who works with people who have what he typically has referred to as “Internet addiction.” He mostly sees this in teens and young adults, and has even had to place clients in residential treatment. But he points out that while people might come to play games for different psychological reasons, the games are designed to keep them engaged.

“Video games are actually designed to be addicting,” said Dr. Hyken, who is also author of The Parent Playbook (2012). “The goal is to continually better your score which leads to obsession or addiction. The social aspect of multiple player games creates a sense of belonging to a community of other like-minded people. It can fill a void for loneliness but also create some positive self-esteem. This further enhances the appeal of the on-line, cyber world.”

Unfortunately, what begins as an innocent quest for a sense of community, or something to alleviate boredom and bring pleasure, can turn into addictive behavior. “I don’t think video games addiction is the same as other addictions although it does light up the same pleasure center of the brain that alcohol and drugs impact,” Hyken said. “The question is, ‘How is this impacting an individual’s life?’ A temporary obsession is not the same as one who engages with these games most of his waking hours and is avoiding school or work over a long period of time. In fact, there is not a defined time-line for how much one plays to be considered an addict. That said, when quality of life has been greatly impact, one most likely is an addict.”

“It can get really bad,” he added. “I had a client who shaved his head so he could play more and avoid taking a shower and another client who urinated in a jug so he could play. More typical, however, is the individual who stops going to school and grades suffer. Additionally, these addicts may will become aggressive (tantrums or physically attack) when the parents ‘pull the plug.’”

Hyken said there are questions about this being a “true addiction” because it shares aspects of other addictions, OCD, and other conditions. “It could be the Asperger’s individual looking to make a social connection; or a depressed individual who wants to lose himself in a screen; or an undiagnosed learning disabled student looking to build self-esteem and avoid school work,” Hyken said.

The toughest part of this disorder is that there is no escaping technology. “Unlike alcohol and drugs, which can be avoided in life, one must interact with technology,“ he said.

The trick is to avoid video games, said Van Cleave. First you have to recognize you have a problem.

“I recognized that I was having seriously negative repercussions in my work, my family life, and my overall health,” he said. “I was eating poorly, feeling lousy about myself, and shaping my entire life around events within the game — which includes adjusting sleeping patterns so I could game with ‘;friends’ from New Zealand.”

He decided he had to quit — cold turkey. His family did not want to help because they were angry at him for his years of ignoring them in favor of his addiction. He knew of no 12-step program at the time. Van Cleave said withdrawal was rough.

“I couldn’t eat,” he said. “I got headaches. I couldn’t sleep at night for weeks. I suddenly realized I had hands and I no longer knew what to do with them. I continued to run game scenarios in my head. It took weeks and weeks to start feeling normal again.”

He said the only thing that got him through was his bullheadedness. On a practical level, he did what he could to remove himself from the game. “I had deleted it from my machine, broke the discs, and changed the online password to something random that I did not know,” he said. “It’d have taken Herculean efforts to figure out how to retrieve the game.”

Now There Is Help For the DisorderVan Cleave said if he had it to do all over again, today, he would seek mental health therapy online. “I didn’t know enough about video game addiction — or addiction in general — to know you couldfind professional help or support,” he said.Since writing his book on the topic, he says more than one thousand people have asked him for help. Although he is not a licensed mental health professional, Van Cleave offers peer support and speaking engagements. He said there is still a stigma associated with this disorder, and without the right help, gamers will retreat back into their game world. 

“My goal is to raise public awareness of the power of the digital world,” said Van Cleave. “It’s not like watching TV. It’s participatory. It’s much more involved in every way, and it affects us far more deeply than any passive experience. If more busy parents realized this, they might be less likely to use video games and the Internet as digital babysitters. They might take the time to know what their kids are playing — and why. The end result of this would be, I believe, better choices about our relationship to the digital world. Hopefully the inclusion of Internet use/abuse in the new DSM will help, too.”

Hyken said that these days there are many places adults and children can find help. But he does not think this new label and inclusion the the DSM-5 will make a huge difference in the way the condition is treated by mental health professionals.”If somebody needs that label to grab onto, to define what their issues are, I think that’s a great place to start,” he said. He is not convinced that consumers will pay attention, but the benefit of a label, he says, is that it can lead to identify symptoms and behavior in a way that might motivate someone to get help.

Stanford Peele, PhD, JD, an addiction expert and author who was an advisor to the American Psychiatric Association on the “DSM-IV-TR”, which was the last version of the manual, said people struggling with this disorder should not be focused on what is listed in the “DSM-5.”

“The DSM-5 has opened the door to the recognition that addiction doesn’t only stem from chemicals,” he said. “The damage and pain you are suffering from gaming or the Internet or whatever should be your guiding light. If you are engrossed by something detrimental to your health, family, community, friends, livelihood — take action. If you can’t shift direction yourself, look around you for help — from a religious figure, family or friends, therapy, a support group — whatever works best for you.”