Behav Sci (Basel). 2015 Dec 15;5(4):602-25. doi: 10.3390/bs5040602.
Three studies assessed the construct of pathological video game use and tested its predictive validity. Replicating previous research, Study 1 produced evidence of convergent validity in 8th and 9th graders (N = 607) classified as pathological gamers. Study 2 replicated and extended the findings of Study 1 with college undergraduates (N = 504). Predictive validity was established in Study 3 by measuring cue reactivity to video games in college undergraduates (N = 254), such that pathological gamers were more emotionally reactive to and provided higher subjective appraisals of video games than non-pathological gamers and non-gamers. The three studies converged to show that pathological video game use seems similar to other addictions in its patterns of correlations with other constructs. Conceptual and definitional aspects of Internet Gaming Disorder are discussed.
In Studies 1 and 2, we tested pathological video-gaming with different populations and different measures. As there are established patterns of comorbidity for other substance and behavioral addictions, such as antisocial personality disorder, we predicted that pathological video-gaming should show similar correlations with hostility , aggressive behaviors , antisocial behaviors, and preference for violence in games. Each of these aspects was demonstrated. Compared with non-pathological gamers, pathological gamers scored higher on measures of trait hostility, engaged in higher levels of antisocial and aggressive behaviors, and had stronger preference for violence in video games. The stronger preference for violence in video games among pathological video-gaming could be argued to be evidence of tolerance [48,49]. In addition, the significant relationships between pathological video-gaming and aggressive and hostile traits imply the potential comorbidity of antisocial personality disorder for pathological video-gaming, although no clinical assessments were made in this study.
For the college sample, the results were very similar to those of younger adolescents despite being measured differently from Study 1. However, some of these relations did not meet the threshold for statistical significance in this older sample. Pathological gamers scored higher on a different personality trait hostility measure, and reported higher levels of antisocial and aggressive behaviors. Pathological gamers were also more likely than non-pathological gamers to report liking more violence in video games. This conceptual replication shows good evidence of the robustness of the construct, but suggests that the effect may be weaker among college students. Although the construct of pathological gaming has been examined in multiple age groups (e.g., [50,51]), far fewer publications have presented examinations of two separate age groups in the same report (e.g., ). Thus, the current work adds to these previous tests in supporting the generalizability of this construct across multiple age groups.
The prevalence of pathological video-gaming was lower in Study 2 than in Study 1 (6% and 12% of gamers, respectively). There are several reasons for the lower prevalence among older adolescents than younger ones. First, we modified our items to be stricter on four dimensions. The items were written to mirror the DSM-IV pathological gambling criteria more closely (because these data were collected prior to DSM-5 being available), whereas for the younger adolescents the items were based on these criteria, but were worded to be understandable to 8th graders. Similarly, two additional items were written to match the DSM more closely, one item was dropped and the diagnostic cut-point was raised for college students. Second, the options provided to respondents were made stricter for college students in Study 2, where most items only had yes/no options, whereas most items had yes/no/sometimes options for younger adolescents and sometimes was grouped with “yes” for most items. Related to this point, we noted some cases of undergraduates marking “do not know” on several items rather than marking “yes”. Several of these cases looked like they were pathological when considering their overall pattern of video game use, but were classified as non-pathological due to our strict criteria. The only potential surprise was that pathological gamers did not differ on their ratings of how frustrating the games were to play. It could be argued from a cue reactivity approach that pathological gamers should find the games more frustrating, but it could also be the case that pathological gamers were likely to be more proficient and therefore would find the games less frustrating. The lack of any significant effect does not shed any light on these two competing hypotheses.
Third, it may be that college students are less vulnerable to pathological video-gaming by virtue of their being a generally high-functioning group. Finally, it may be that developmental differences are implicated, such that younger adolescents are more vulnerable to pathological video-gaming, perhaps because they have fewer competing requirements for their time than college students. This study does not allow us to determine which, if any, of these accounts for the differences in prevalence rates. If there is some bias in our approach with older adolescents, it is possible that our percentages underestimate the prevalence in this age group. A national survey of American youth aged 8 to 18 put the prevalence at 8.5% of gamers . Nevertheless, the significant relations between pathological video-gaming and hostility, aggression, and preference for violence in these two studies converge to suggest that pathological video-gaming as measured by a DSM-style checklist shows patterns similar to other addictions.
In Study 3, each participant played three games and provided information on their emotional states and judged several dimensions of the games. Theoretically, pathological gamers should show evidence of heightened reactivity. As hypothesized, pathological gamers reported greater changes in emotional states and rated their experiences of playing the games as more positive than non-pathological gamers and non-gamers.
Pathological gamers’ pattern of emotional reactions to playing games was complex, however, and our interpretation should be viewed with caution until further research can replicate it. One interpretation is that pathological gamers reported less agitation and irritation after playing perhaps because it provided a “fix”. Pathological gamers reported feeling less lonely, sad, and unhappy and more energetic after playing. Given that one criterion for addiction is that the player is motivated to play to escape from negative emotional states, these data support the idea that pathological gamers associated games with decreased negative feelings. However, they also reported feeling less calm, peaceful, and pleasant. This appears very similar to traditional cue reactivity, where presentation with an addiction-related stimulus increased symptoms of withdrawal and craving (e.g., [52,53]). In addition, the picture is unclear when considering happiness and anger. Some pathological gamers were more likely to be happier and less mad after playing, but some showed the opposite pattern. It is possible that these results were due in part to the checklist approach to measuring emotion, rather than by asking how mad participants felt. We would recommend that future research measuring emotional responses to games rate how much they feel each, rather than the dichotomous checklist used by the MAACL. If nothing else, this would be more sensitive to change. Note that this is not identical to traditional cue reactivity, as playing a video game for 20 minutes is more than a “cue”. Nonetheless, the data supported the primary hypothesis that pathological gamers would be more emotionally reactive to playing video games.
When rating the gaming experience for each game, pathological gamers rated the games significantly more favorably than both non-gamers and non- pathological gamers. They considered the games to be more entertaining, exciting, fun, absorbing, arousing, enjoyable, involving, stimulating, and addicting than non-gamers and non- pathological gamers. They also rated the games as less boring than other participants. As predicted, they did not differ on ratings of more objective characteristics of the games, such as how violent, action-packed, or difficult the games were. It is for this reason that some researchers have included a “sometimes” category and have scored it as halfway between a “yes” and a “no” [6,46].
Several definitional issues remain to be studied. For example, we based our categorization on DSM-style criteria, where participants who answered yes to five or more of the diagnostic criteria were classified as pathological gamers and all others were classified as non-pathological. The studies reported here provide some evidence of validity for this dichotomous categorical approach using a cut-off point. However, the number of the diagnostic criteria a gamer presents to indicate levels of disorder could be equally useful. The fact that we found greater test-retest reliability for the number of criteria present than for whether the participants fell above or below our cut point suggests that additional studies should examine this issue, although we recognize the clinical value of introducing cut-off values for diagnostic purposes. Perhaps there are degrees of pathological use that would represent different challenges and would need to be treated differently. A related issue concerns how well checklist-style screening tools can differentiate highly engaged gamers from pathological gamers (e.g., [51,54]). The recent publication of the DSM-5 guidelines has led to what is becoming a very fruitful debate about which symptoms may best discriminate highly engaged from pathological levels (e.g., [31,55,56,57,58,59]). Indeed, this may currently be the largest challenge in the field. The studies presented here were not designed to provide a test of these questions, unfortunately, although we hope that the data may be useful for the discussion. For example, if a more conservative test were used (such as requiring the most problematic items, perhaps damage to grades and lying, to be endorsed for one to be considered pathological), the prevalence rates drop, but the overall pattern of correlations with other problem behaviors persists.
Our hypotheses were based on the theoretical position that most types of addictions should show similar patterns of correlations, such as with higher hostility and antisocial behaviors. Although this was largely confirmed, it is worth considering why that might be. There is no necessary reason why pathological gaming should predict aggressive behaviors. Our speculation is that this pattern is likely indicative of an underlying impulse-control problem, which is how we currently consider Internet Gaming Disorder. Future studies should test this hypothesis.
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