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  • Problematic Technology (March/April)
  • Video Game Addiction

Video Game Addiction

The Carlat Child Psychiatry Report, Volume 4, Number 2, March 2013
https://www.thecarlatreport.com/newsletter-issue/ccprv4n2/

From The Carlat Child Psychiatry Report, March 2013, Problematic Technology

Issue Links: Learning Objectives | Editorial Information | PDF of Issue

Topics: Child Psychiatry | Cultural Competence | Free Articles

Print Friendly, PDF & Email

Sanjay H. Patel, MD

Video games have come a long way since Pac Man and Tetris. Games today simulate reality in massive user-generated worlds. Players chat by voice or text with people around the globe. Virtual characters work for gold, get married, become sick, and even host religious gatherings. Psychologically, games allow players to avoid real life while engaging and even succeeding in a semi-real fantasy world.

Video games are pervasive among youth culture. There’s not a child psychiatrist out there who doesn’t see patients who play games at least sometimes. Learning which type of game your patients are playing is a great way to build rapport. Recently I saw a boy who had huge fights with his parents about turning off his game after school. After learning more, I convinced him to play an older style game (which you can turn off easily) after school, and a more interactive game later, which led to less conflict and better grades.

The online, collaborative aspect of modern games is what makes them so interesting, insidious, and addictive. In the past, kids could spend hours playing a game, press pause to eat dinner, and then return to the game without missing a beat. Because many of today’s games are often interactive, if you step away, you might miss something.

Part of the appeal of these games can be explained by the classic New Yorker cartoon: “On the Internet, nobody knows you’re a dog.” Online, kids are able to recreate themselves—or not. The Asian teenager whose parents don’t speak English is able to be a talkative warrior. The socially phobic girl might find that she can make friends more easily online than in school, even if she keeps the same personality—or she might prefer to wander the virtual world by herself.

Video Games and Violence

We can’t talk about games without discussing violence. The link between video games and violence is unclear. There is a sense that violent video games could desensitize kids to violence, but there is no conclusive evidence that links video games with major violence, partly because major acts of violence are so rare (Ferguson CJ et al, J Youth Adolescence 2013;42(1):109–122). However you look at it, video games can be just one of many factors in real world violence.

For medicolegal reasons, if your patient is spending hours playing games, it is worth asking whether they are violent shooting games. If so, then follow up about guns in the house and violent plans, just to make sure that the game isn’t a trial run for something sinister.

Gaming Addiction

In terms of understanding and treating video game addiction, the United States is behind Asia. In countries such as South Korea and China, video game addiction is considered to be an urgent public health issue.

Asian awareness of video game addiction stems from two main factors. First, there were a series of high profile deaths connected to gaming, including a couple that took care of a virtual infant while their real infant starved to death, and a man who refused medical attention for shortness of breath because he did not want to stop playing. Second, in Asia, these games are typically played in Internet cafes—in comparison to the United States, where home computer usage is the norm—so video game addicts are more visible in public.

In the US, we tend to treat the comorbid disorders, which are present in about 86% of patients who are addicted to video games (Block JJ, Am J Psychiatry 2008;165:206–307). In Asia, therapists tend to screen for Internet addiction as part of the initial assessment, making that a specific treatment focus.

Not aggressively screening for and treating video game addiction is a mistake on our part. Our patients were born with technology integrated into their lives. For many of them, it may not be strange to develop a simulated character at the expense of their own character. Asking whether they play video games with their school friends or only online friends is a good way to find out whether the games are a continuation of offline life or something separate.

Ongoing studies around the world show that heavy users tend to play up to 20 and 30 hours, and sometimes more than 40 hours per week (Haagsma MC et al, Cyberpsychol Behav Soc Netw 2012;15(3):162–168). Most video gamers are male, and they often play well into their 20s. Female gamers often play for fewer hours, but have higher depression and social phobia ratings than male players (Wei HT et al, BMC Psychiatry 2012;12(1):92).

Say What? Gamer Terms for the Uninitiated

MMORPG (Massively multiplayer online role-playing game): A fantasy game where an individual develops a character and interacts with other players from around the world. These games often involve magic and a fantasy world, and do not have an ending. The goal is to develop your character and interact with other characters. The most famous example is World of Warcraft, a game with 10 million online subscribers, half of them in Asia. FPS (First-person shooter): An action game with a first-person perspective, usually detailed, graphic, and often with realistic military-style weaponry. The best-known FPS game is Call of Duty, a game so popular that each year’s version earns more than $1 billion, often in less than a month. (Compare that to the most popular movies of all time, which earn about the same amount.) Players go online to play matches where the goal is to kill the other players. They often use an online service such as Xbox Live to play this game online.

Treating Video Game Addiction

Treatment is multifactorial. Most important, we need to recognize that it’s worth discussing. Patients have to feel comfortable talking about their excessive gaming habit, which can be difficult when it has to do with things like monsters and magic. In fact, talking about gaming can feel dangerous for patients, because they feel powerful and successful when playing, but that feeling can disappear rapidly when discussing it in an office.

In terms of medication, there is only a small study of 11 patients who took bupropion (Wellbutrin) and played 25% fewer hours of video games (Han DH et al, Exp Clin Psychopharmacol 2010;18(4):297–304). Anecdotally, one of my patients had a similar result with Wellbutrin XL 300 mg.

The general approach is to have the patient spend more time in the real world and less time in the virtual world. Finding ways to engage the patient in the offline world is one way to approach this—preferably suggesting things that encourage psychological and social development. This can be as simple as joining a sports team or engaging in physical exercise, or as exotic as sending a patient on an outdoor adventure program (Outward Bound, NOLS, Overland) where computer time is very limited. South Korea has camps dedicated for video game addiction.

A family-wide approach to treatment can be useful, because patients addicted to video games may not have the motivation to change on their own. Use games as rewards for engaging in other activities, have parents keep the power cord, and limit screen time to weekends or evenings only. I tell parents to use a kitchen timer, which keeps the game to under an hour, and puts the blame on an object (the timer) rather than on the parents. Finally, consider making the family vacation “electronic-free,” although some families discover the child is not the only member of the family jonesing for a fix.

Sanjay H. Patel, MD

Fellow, child and adolescent psychiatry, Clinical instructor, child and adolescent psychiatry, New York University

Dr. Patel has disclosed that he has no relevant relationships or financial interests in any commercial company pertaining to this educational activity.

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The Child Medication Fact Book for Psychiatric Practice (2018)
Issues Archives

2022

  • ADHD in Children and Adolescents (April/May/June)
  • Assessment in Children and Adolescents (January/February/March)

2021

  • Overarousal in Children and Adolescents (Oct/Nov/Dec)
  • Substance Use in Children and Adolescents (Jul/Aug/Sep)
  • Autism in Children and Adolescents (April/May/June)
  • Clinical Complexity With Children and Adolescents (Jan/Feb/Mar)

2020

  • Esketamine (January)
  • Telepsychiatry (May)
  • Mind-Gut Connection (January)
  • Practical Psychotherapy (November/December)
  • Mood and Menopause (October)
  • When to Use Lithium (September)
  • Traumatic Brain Injury (August)
  • Borderline Personality Disorder (June/July)
  • Psychopharmacology Algorithms (April)
  • Bipolar II (March)
  • Inflammation and Depression (February)

2020

  • Mood Disorders in Children and Adolescents (Oct/Nov/Dec)
  • Identity & Culture in Children and Adolescents (July/August/September)
  • Psychosis in Children and Adolescents (April/May/June)
  • ADHD in Children and Adolescents (Jan/Feb/Mar)

2020

  • Harm Reduction (January/February)
  • Substance Use in Health Professionals (March/April)
  • Alternative Treatment in Addiction (November/December)
  • Social Aspects of Addiction (September/October)
  • Opioid Use Disorder Treatment (July/August)
  • Emerging Risks for Old Medications (May/June)

2019

  • Depression (May)
  • Adult ADHD (November/December)
  • Mental Health Apps (October)
  • How to Talk about Medication (September)
  • Side Effects Part II (August)
  • Side Effects Part I (June/July)
  • Sleep (April)
  • Parenting, Pregnancy, and Prevention (March)
  • Dark and Light Therapy (February)
  • Deprescribing (January)

2018

  • Drug Metabolism (November/December)
  • Working With Transgender Patients (October)
  • Emergency Psychiatry (September)
  • Treatment-Resistant Depression (July/August)
  • Neurobiology (June)
  • Anxiety (May)
  • Neurofeedback (April)
  • Antipsychotics Update (March)
  • Working With Families (February)
  • Bipolar Disorder (January)

2017

  • PTSD (December)
  • Retirement (November)
  • Intellectual Disability (September/October)
  • Antidepressants (July/August)
  • Personality Disorders (June)
  • Dementia (May)
  • Cognitive Behavior Therapy Techniques (April)
  • Pharmacogenetics (March)
  • Treating Psychosis (February)
  • Adult ADHD (January)

2016

  • Complementary and Alternative Medicine in Psychiatry (November/December)
  • Side Effects (October)
  • Pain Management (September)
  • Medication in Pregnancy (July/August)
  • Psychoanalysis in Modern Psychiatry (June)
  • Correctional Psychiatry (May)
  • Antidepressant Roundup (April)
  • Burnout (March)
  • Private Practice (February)
  • Bipolar Disorder (January)

2015

  • Psychiatry and General Medicine (November/December)
  • Biomarkers in Psychiatry (May)
  • Telepsychiatry (October)
  • Sleep Disorders (September)
  • Interventional Psychiatry (July/August)
  • Eating Disorders (June)
  • Psychotherapy Updates (April)
  • Topics in Geriatric Psychiatry (March)
  • Antipsychotics Update (February)
  • Risk Management (January)

2014

  • Bipolar Disorder (November/December)
  • Pharmacogenetics (October)
  • Keeping up in Psychiatry (September)
  • Research in Psychiatry (July/August)
  • Marijuana (June)
  • Psychiatric Diagnosis (May)
  • Issues in Psychopharmacology (April)
  • Schizophrenia (March)
  • Women’s Psychiatry (February)
  • Ethics in Psychiatry (January)

2013

  • Military Psychiatry (December)
  • Depression (November)
  • Treatment of Dementia (October)
  • Anxiety Disorders (September)
  • Natural and Alternative Treatments in Psychiatry (July/August)
  • Autism Spectrum Disorder (June)
  • Practice Tips (May)
  • Substance Abuse (April)
  • Medicolegal Topics (March)
  • End of Life Care (February)
  • Antipsychotic Update (January)

2012

  • Screening Tools and Tips (December)
  • Medical Comorbidities (November)
  • Devices in Psychiatry (October)
  • Eating Disorders (September)
  • Bipolar Disorder (July/August)
  • Risk Management (June)
  • Antidepressant Roundup 2012 (May)
  • Gender and Sexuality (April)
  • Personality Disorders (March)
  • ADHD (February)
  • Natural Treatments in Psychiatry (January)

2011

  • Electronic Medical Records (December)
  • Insomnia (November)
  • Psychotherapy (October)
  • Alcoholism (September)
  • Anxiety Disorders (July/August)
  • Schizophrenia (June)
  • Managing Side Effects (May)
  • Antidepressant Roundup 2011 (April)
  • DSM-5 and Diagnostic Issues (March)
  • Drug-Drug Interactions (February)
  • Bipolar Disorder (January)

2010

  • Hospital Psychiatry (December)
  • Psychiatric Medication in Pregnancy (November)
  • Maintenance of Certification (October)
  • The Neuroscience of Psychotherapy (September)
  • Treatment of Depression (July/August)
  • Email and the Internet in Psychiatry (June)
  • Substance Abuse (May)
  • The Diagnosis and Treatment of Dementia (April)
  • Ethics in Psychiatry (March)
  • Natural Treatments in Psychiatry (February)
  • ADHD (January)

2009

  • Treating Schizophrenia (December)
  • Treatment for Anxiety Disorders (November)
  • The Latest on Antidepressants (October)
  • Topics in Neuropsychiatry (September)
  • The Interface of Medicine and Psychiatry (July/August)
  • Generic Medications in Psychiatry (June)
  • The Treatment of Eating Disorders (May)
  • Healthcare Policy and Psychiatry (April)
  • Antipsychotic Roundup 2009 (March)
  • Psychiatric Medication in Pregnancy and Lactation (February)
  • Transcranial Magnetic Stimulation (January)

2008

  • Treating Fibromyalgia and Pain in Psychiatry (December)
  • Issues in Child Psychiatry (November)
  • Improving Psychiatric Practice (October)
  • Treating Personality Disorders (September)
  • Bipolar Disorder (July/August)
  • Antipsychotic Roundup 2008 (June)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Neuropsychological Testing (May)
  • Psychiatric Medications: Effects and Side Effects (April)
  • Update on Substance Abuse (March)
  • Anticonvulsants in Psychiatry (February)
  • Brain Devices in Psychiatry (January)

2007

  • The Treatment of Insomnia (December)
  • Avoiding Malpractice in Psychiatry (November)
  • Update on Eating Disorders (October)
  • Complex Psychopharmacology (September)
  • Laboratory Testing in Psychiatry (August)
  • Psychotherapy in Psychiatry (July)
  • Posttraumatic Stress Disorder (June)
  • Topics in Geriatric Psychiatry 2007 (May)
  • Pregnancy and Menopause in Psychiatry (Apil)
  • Antipsychotic Roundup 2007 (March)
  • Understanding Psychiatric Research (February)
  • Antidepressant Round-up 2007 (January)

2006

  • Technology and Psychiatric Practice (December)
  • The Use of MAOIs (November)
  • Medication Treatment of Depression (January)
  • Seasonal Affective Disorder (October)
  • Treatment of ADHD (September)
  • Topics in Bipolar Disorder (August)
  • Neurotransmitters in Psychiatry (July)
  • Treating Substance Abuse (June)
  • The STAR*D Antidepressant Trial (May)
  • Natural Treatments in Psychiatry (April)
  • Medication Treatment of Anxiety (March)
  • Panic Disorder: Making Treatment Work (March)
  • Antipsychotic Roundup 2006 (February)
  • Antidepressant Roundup 2006 (January)

2005

  • Self-Help Books and Psychiatry (December)
  • Genetics and Psychiatry (November)
  • Pregnancy and Psychiatric Treatment (October)
  • Benzodiazepines and Hypnotics in Psychiatry (September)
  • Geriatric Psychiatry Update (August)
  • Chart Documentation in Psychiatry (July)
  • The Treatment of Bipolar Disorder (June)
  • Weight Loss and Smoking Cessation in Psychiatry (May)
  • Treating ADHD (April)
  • Drug Industry Influence in Psychiatry (March)
  • Atypical Antipsychotics 2005 (February)
  • Antidepressant Roundup 2005 (January)

2004

  • Sexual Dysfunction (December)
  • Suicide Prevention (November)
  • To Sleep, To Awake (October)
  • Women’s Issues in Psychiatry (September)
  • OCD: An Update (August)
  • Chronic Pain and Psychiatry (July)
  • Neuroimaging in Psychiatry (June)
  • Natural Medications in Psychiatry (May)
  • Posttraumatic Stress Disorder (April)
  • Treatment of Alcoholism (March)
  • Battle of the Atypicals (February)
  • Antidepressant Roundup, 2004 (January)

2003

  • Research Methods in Psychiatry (December)
  • Antidepressants in Children (November)
  • The Treatment of Dementia (October)
  • Bipolar Disorder, Part II: The Novel Anticonvulsants (September)
  • Bipolar Disorder: The Basics (August)
  • Drug-Drug Interactions in Psychiatry (July)
  • Managing Antidepressant Side Effects (June)
  • Antidepressants in Pregnancy and Lactation (May)
  • ADHD: Medication Options (April)
  • Panic Disorder: Making Treatment Work (March)
  • Atypical Antipsychotics in Clinical Practice (February)
  • Medication Treatment of Depression (January)

2019

  • Autism in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (May/June/July/August)
  • Substance Use in Children and Adolescents (September/October)
  • Trauma in Children and Adolescents (March/April)
  • Anxiety in Children and Adolescents (January/February)

2018

  • Psychotropic Risks in Children and Adolescents (May/June)
  • ADHD in Children and Adolescents (November/December)
  • Depression in Children and Adolescents (September/October)
  • Autism in Children and Adolescents (July/August)
  • Anxiety in Children and Adolescents (March/April)
  • Suicide in Children and Adolescents (January/February)

2017

  • Adolescents (November/December)
  • ADHD in Children and Adolescents (September/October)
  • Psychosis in Children and Adolescents (August)
  • PANDAS, PANS, and Related Disorders (June/July)
  • Marijuana in Children and Adolescents (May)
  • Tourette’s and Other Tic Disorders in Children and Adolescents (March/April)
  • Autism in Children and Adolescents (January/February)

2016

  • Gender Dysphoria in Children and Adolescents (November/December)
  • Technology Issues With Children and Adolescents (September/October)
  • Mood Dysregulation in Children and Adolescents (July/August)
  • Eating Disorders in Children and Adolescents (May/June)
  • Conduct Disorder in Children and Adolescents (April)
  • Sleep Disorders in Children and Adolescents (March)
  • ADHD in Children and Adolescents (January/February)

2015

  • Antidepressant Use in Children (November/December)
  • Foster Care and Child Psychiatry (September/October)
  • Autism (July/August)
  • Trauma (May/June)
  • Anxiety Disorders (April)
  • Schools and Psychiatry (March)
  • Emergency Psychiatry in Children (January/February)

2014

  • Antipsychotics in Children (December)
  • ADHD (November)
  • Gender and Sexuality (September/October)
  • Psychotic Symptoms (Summer)
  • Medication Side Effects (May)
  • Food and Mood (April)
  • Learning and Developmental Disabilities (February)

2013

  • Complex Practice Issues (December)
  • Diet and Nutrition (November)
  • Child Psychiatry in DSM-5 (August/September)
  • Medication Side Effects and Interactions (June/July)
  • Problematic Technology (March/April)
  • Autism Spectrum Disorders (January/February)

2012

  • Bipolar Disorder (December)
  • Substance Abuse (October/November)
  • Transitional Age Youth (July/August)
  • Rating Scales (May/June)
  • Eating Disorders (March/April)
  • Behavioral Disorders (February)

2011

  • Treatment of Anxiety Disorders (December)
  • Trauma (November)
  • Bullying and School Issues (October)
  • Hidden Medical Disorders (August)
  • OCD and Tic Disorders (June)
  • Suicide and Non-Suicidal Self Injury (April)
  • Sleep Disorders (March)
  • ADHD (January)

2010

  • Use of Antipsychotics in Children and Adolescents (December)
  • Learning and Developmental Disabilities (October)
  • Major Depression (September)
  • Treating Children and Families (July)
  • The Explosive Child (May)

2019

  • Dual Diagnosis in Addiction Medicine (May/June)
  • Medical Issues in Addiction Practice (November/December)
  • Alcohol Addiction (September/October)
  • Legal Issues in Addiction Medicine (July/August)
  • Traumatic Brain Injury and Addiction (March/April)
  • Board Certification in Addiction Medicine (January/February)

2018

  • Opioid Addiction (November/December)
  • Addiction in Older Adults (October)
  • Sleep Disorders and Addiction (September)
  • Adolescent Addiction (July/August)
  • Pain and Addiction (May/June)
  • Cannabis and Addiction (March/April)
  • Stigma and Addiction (January/February)

2017

  • Pregnancy and Addiction (November/December)
  • Detox (Sepember/October)
  • Dual Diagnosis (August)
  • Alternatives to 12-Step Programs (June/July)
  • Recovery (May)
  • Psychiatric Uses of Street Drugs (March/April)
  • Sex Addiction (January/February)

2016

  • Prescription Drug Monitoring Programs (PDMPs) (November/December)
  • Addiction in Health Care Professionals (September/October)
  • Dialectical Behavior Therapy in Addiction (August)
  • Motivational Interviewing (June/July)
  • Benzodiazepines (May)
  • Opioid Addiction (March/April)
  • Families and Substance Abuse (January/February)

2015

  • The Twelve Steps (November/December)
  • Designer Drugs (September/October)
  • Residential Treatment Programs Decoded (July/August)
  • Nicotine and E-Cigarettes (June)
  • Drug Screening (April/May)
  • Integrating Therapy and Medications for Alcoholism (March)
  • Detoxification Protocols (January/February)

2014

  • Behavioral Addictions (December)
  • Risk and Reimbursement (November)
  • Stimulant Abuse (September/October)
  • Self-Help Programs (June)
  • Opioid Addiction (May)
  • Coping with Bad Outcomes (March)
  • Change Management in Addiction Treatment (January/February)

2013

  • Cocaine Addiction (December)
  • Relapse Prevention (November)
  • Cannabis Addiction (August/September)
  • Addiction in DSM-5 (June/July)
Editor-in-Chief

Joshua D. Feder, MD

Dr. Joshua Feder studied mathematics and medicine at Boston University, Psychiatry at Naval Regional Medical Center San Diego, serving the first gulf war in child and adolescent psychiatry fellowship at Tripler Army Medical Center in Honolulu, and eventually becoming Chief of Child Psychiatry at the National Naval Medical Center in Bethesda, MD. Dr. Feder now practices in Solana Beach, California and serves as Medical Director at Positive Development, providing relationship-based support for families, with research at UCSD, SDSU, Fielding Graduate University, An Najah National University, Quicksilver Software, Autism Is inclusion program, and Programmatic Lead for the International Networking Group on Peace Building with Young Children, with projects in the US, Northern Ireland, and the Middle East. Dr. Feder co-authored the first American Academy of Child & Adolescent Psychiatry Practice Parameter on Autism and serves on the Disaster & Trauma Committee and the Resource Group on Youth at the Border. Dr Feder was founding policy chair for the California Association for Infant Mental Health, and advocates worldwide on access to care, climate policy, and peacebuilding. His recent books include Child Medication Fact Book for Psychiatric Practice (2018) and Prescribing Psychotropics (2021).

Full Editorial Information

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