presentation on games addiction

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2023 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

What Is Video Game Addiction?

Definition, Symptoms, Effects, Treatment, and Coping

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Carol Yepes / Moment / Getty Images

Understanding Video Game Addiction

Video game addiction is the compulsive or uncontrolled use of video games, in a way that causes problems in other areas of the person's life.

Often considered a form of computer addiction or internet addiction , video game addiction has been an increasing concern for parents as video games have become more commonplace and are often targeted at children.

Video games include computer games, console games, arcade machine games, and even cell phone, and advanced calculator games. Games can be embedded in social networking sites, such as Facebook.

Since the 1950s, gaming has grown into a multi-billion dollar industry. Some people are concerned about the long-term effects of video game playing, particularly in children. Concerns center on the following questions:

• “Are video games harmful?”
• “Do violent video games cause aggression?”
• “Are video games addictive?”

While research is inconclusive, there does appear to be evidence that video games can be harmful, can increase aggression, and can be addictive. However, these effects are highly individual and may involve many more factors than simply the amount of time spent playing games.

Signs of Video Game Addiction

Some symptoms of video game addiction can include:

• Neglecting duties at work, home, or school in order to play video games
• Thinking about video games all the time
• Not being able to decrease playing time even when you try
• Continuing to play despite the problems video games cause in your life
• Playing video games to deal with anxiety, bad moods, or negative feelings
• Feeling upset if you are not able to game
• Not doing other things you used to enjoy in order to play video games
• Hiding how much time you spend playing video games or lying about your gaming habits

Playing video games a lot is not necessarily a sign of a video game addiction, however. Some people are simply very enthusiastic about them and that is how they enjoy spending their free time. If gaming creates distress and interferes with a person's ability to function in their life, then it might be a sign that there is a problem.

How Common Is Video Game Addiction?

Research studies show that 1% to 16% of video gamers meet the criteria for addiction. However, the official definition of video game addiction varies across different organizations. Considering this, it is easy to be confused about whether your or someone else’s gaming falls in the average or heavy ranges.

As with all addictions, it is important when considering the possibility of a video game addiction to not simply consider the amount of time spent gaming, but also the function it is serving the individual. Video game playing, as one of a range of recreational activities, may not be harmful or indicate an addiction.

When game playing is addictive, it takes over as the person’s main way of coping with life, with other important areas of life being neglected or disrupted as a result.

Video game addiction or video game overuse is seen most commonly in players of the persistent multiplayer gaming universe, or Massive Multiplayer Online Role-Playing Game—MMORPG games for short. MMORPGs make up 25% of gaming revenue worldwide.   These games hold many attractions for gamers—they are interactive, social, competitive, and happen in real-time.

Research indicates that MMORPGs are more addictive in nature. As a result, they tend to have greater negative impacts on physical health, sleep habits and academic performance.  

Diagnosis of Video Game Addiction

Like other behavioral addictions , video game addiction is a controversial idea. While video gaming research is showing some disturbing effects, particularly in younger players, there is a lack of long-term research and insufficient evidence to definitively conclude that video game overuse is indeed an addiction.

In addition, cautionary messages from groups, such as the American Medical Association, which believes that video games are potentially harmful, have to compete with the aggressive marketing of the video games industry, whose own research, unsurprisingly, shows no ill effects.

Currently, it is not recognized as a distinct condition in the " Diagnostic and Statistical Manual of Mental Disorders " (DSM-5-TR), the "gold standard" reference for mental health conditions. Internet gaming disorder, however, is included as a condition for further study in the DSM.

Although it is not yet recognized fully as a disorder, proposed criteria have been published.

To be diagnosed, gaming behavior must be severe enough that it creates significant problems in different areas of life, including home, work, family, school, and other areas. Symptoms must also be present for a year or longer.

Similarity to Other Addictions

Video game addictions are similar to other addictions in terms of the amount of time spent playing, the strong emotional attachment to the activity, and the patterns of social difficulties experienced by gaming addicts.

As with other addictions, gaming addicts become preoccupied with game-playing, and it disrupts family and other areas of life, such as school.

The younger that children begin playing video games, the more likely they are to develop dependence-like behaviors.

As with other addictive behaviors, there is a range of different responses to the activity. While some gamers feel unable to reduce the time they spend playing, others do not experience cravings if they are unable to play.

Effects of Video Game Addiction

Some studies suggest that violent video games may increase aggressive thoughts and behaviors. However, there is conflicting research on this, and some studies have not found this effect or suggest that it is influenced by other factors such as moral disengagement and disinhibition.

Research on people who are addicted to video games shows that they have poorer mental health and cognitive functioning including poorer impulse control and ADHD symptoms , compared to people who do not have video game addiction.

People who are addicted to video games also have increased emotional difficulties, including increased depression and anxiety, report feeling more socially isolated, and are more likely to have problems with internet pornography use.

Treatment for Video Game Addiction

Cognitive behavioral therapy (CBT) is a type of therapy that can be helpful in the treatment of behavioral addictions such as video game addiction.

Working with a therapist, people learn to identify the thoughts that contribute to excessive, compulsive video game use. Once people learn to recognize these thoughts, they can then work to replace them with ones that are more helpful and productive.

Therapy can also help people develop different coping strategies to deal with feelings of stress and distract themselves from urges to play video games.

Coping With Video Game Addiction

If you suspect that you have a video game addiction or simply want to reduce your video game use, there are strategies you can use that can help. Some things you can try include:

• Setting limits on your video game use : Decide how much you want to play each day. Set aside a specific block of time and set a timer so you'll know when it is time to quit. Consider enlisting the help of a friend to help keep you accountable.
• Find distractions : Look for other things to hold your interest and fill your time when you feel the urge to play video games. Going for a walk, calling a friend, watching a movie, or reading a book are a few ideas, but trying out new hobbies and interests can also serve as welcome distractions.
• Keep electronics out of your bedroom : Keep gaming systems, phones, and other electronic devices out of your bedroom so you aren't tempted to play games in the evening or before bedtime.
• Practice relaxation techniques : If you are playing games in order to cope with feelings of stress or anxiety, try replacing your gaming habit with other effective coping strategies. Relaxation techniques such as deep breathing , mindfulness meditation , and yoga can be a great way to unwind and destress without having to rely on video games.

If you or a loved one are struggling with addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database .

Li AY, Chau CL, Cheng C. Development and validation of a parent-based program for preventing gaming disorder: The game over intervention . Int J Environ Res Public Health . 2019;16(11). doi:10.3390/ijerph16111984

Jeromin F, Nyenhuis N, Barke A. Attentional bias in excessive internet gamers: Experimental investigations using an addiction Stroop and a visual probe . J Behav Addict . 2016;5(1):32-40. doi:10.1556/2006.5.2016.012

Hong JS, Kim SM, Jung JW, Kim SY, Chung US, Han DH. A comparison of risk and protective factors for excessive internet game play between Koreans in Korea and immigrant Koreans in the United States . J Korean Med Sci. 2019;34(23):e162. doi:10.3346/jkms.2019.34.e162

American Psychiatric Association (APA).  Diagnostic and Statistical Manual of Mental Disorders . 5th ed, text revision. Washington, D.C.; 2022.

Yao M, Zhou Y, Li J, Gao X. Violent video games exposure and aggression: The role of moral disengagement, anger, hostility, and disinhibition . Aggress Behav . 2019;45(6):662-670. doi:10.1002/ab.21860

Ra CK, Cho J, Stone MD, et al. Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents . JAMA . 2018;320(3):255-263. doi:10.1001/jama.2018.8931

Stockdale L, Coyne SM. Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls . J Affect Disord . 2018;225:265-272. doi:10.1016/j.jad.2017.08.045

By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada. 

Filed under:

Video game addiction is real, rare, and poorly understood

The World Health Organization now recognizes “gaming disorder.” It’s a controversial, but some argue necessary, classification.

Share this story

• Share this on Facebook
• Share this on Twitter
• Share this on Reddit
• Share All sharing options

Share All sharing options for: Video game addiction is real, rare, and poorly understood

Scott knew he needed to focus on his work. His bosses were increasingly unhappy with his performance, and he was struggling to earn enough to support his wife and son. As he put it to me, “I was falling down on my job.”

Something else had consumed his attention: Scott just couldn’t stop playing video games.

As a computer programmer working from home, it was easy for Scott, now 45, to turn on a game at any time. And increasingly, he found himself playing instead of working — a problem for someone who was paid by the hour and was honest in reporting his hours.

Scott played online card games like Absolute Poker and Bridge Base Online , and massively multiplayer online roleplaying games like World of Warcraft and Final Fantasy XI . He was, he said, “obsessed” with the escape that they offered him. “Even when I wasn’t gaming, I was thinking about gaming,” Scott, who asked I not use his last name, told me.

Scott had previously battled alcohol addiction. And he said gaming addiction began the same way: with a sense of despair — that “life just seemed pointless in a lot of ways.” Then came an escalation of use that over time crowded out the other things in his life.

His life deteriorated. He neglected his now-ex-wife and son. He abandoned his other hobbies. He lost sleep. His social life evaporated.

After years of this, Scott found help groups online in 2010 and tried to moderate his gaming. “I’m going to try it again, but I’m not going back to that old craziness,” he told himself. “It’ll just be a little bit here and there. I know now what it does to me. I know better than to get back into it.”

But Scott would eventually relapse — letting games dominate all his priorities once again. It wasn’t until 2012, when he totally quit games (with the help of support groups like CGAA ), that he turned his life around, improving his relationships and work, and getting back to his other hobbies.

Public health experts now are starting to take stories like Scott’s more seriously. This year, the World Health Organization (WHO) for the first time recognized “gaming disorder” in the 11th Revision of the International Classification of Diseases (ICD-11). In doing so, the WHO joined the American Psychiatric Association (APA), which had previously added “internet gaming disorder” as a phenomenon worthy of more research in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The WHO’s designation in particular drew quick skepticism from gamers , experts , and gaming and tech websites. To many gamers, the issue was personal: They felt that their hobby was being scapegoated as a societal problem. Having not experienced anything close to addiction themselves, they felt that the WHO’s designation was made without any good evidence.

Those who support the designation, though, note that the majority of gamers wouldn’t experience anything close to addiction. As is true for most other addictive activities and substances, the great majority of people who play games are not going to be addicted.

But some people truly do struggle with gaming addiction — a legitimate medical condition, the WHO argues. The idea behind the designation is to acknowledge that this group needs health care and other resources for help.

What’s more, there are aspects of games that may make them particularly susceptible to addiction, including their unique abilities to immerse, the easy access to them, and the gambling-like mechanics that have increasingly popped up in games in recent years.

Unpacking all of that, though, requires not just understanding video games, but also addiction — which continues to be greatly misunderstood in America.

Video games are now mainstream — and that comes with some risks

It was only a few decades ago when video games were seen as a niche activity. When I was in high school, gamers were nerds.

That’s now changed. With the rise of phenomenon like Pokémon , World of Warcraft , Call of Duty , and Fortnite , games are now mainstream. According to Statista , the number of active gamers worldwide will rise to more than 2.7 billion people in 2021, up from 1.8 billion in 2014 and 2.3 billion in 2018.

The great majority of these people will not become addicted to video games. Based on some of the best research , 1 to 3 percent of gamers are at risk.

This is true for other kinds of addiction, even for drugs that are considered highly addictive. For example, some research estimates that about 8 percent of opioid painkiller patients get addicted — still a significant amount, but definitely not a majority.

But when billions of people around the world are playing games, even a small percent can lead to a large population — literally tens of millions — with problems.

The WHO’s designation is meant to get ahead of this problem. It creates a basis that the health care system can build a response around. Doctors will have a condition to diagnose patients with. It enables more research into the disorder. And health insurers will be pushed to pay for treatment as it’s recognized as a real medical condition.

Joël Billieux, a University of Luxembourg professor involved in clinical and research work on gaming disorder, argued that’s why the WHO designation is necessary.

“It will allow the systemization of education and prevention,” Billieux, who served on the WHO’s gaming disorder committee, told me. “There will also be more means for doing research and better understanding the condition.”

“Yet, on the opposite side,” Billieux added, “it’s legitimate to be concerned about the risks of pathologization of normal behavior or unnecessary treatment.”

That latter concern is what’s driven a lot of the opposition to the WHO’s designation. Coming from researching video games and violence, Stetson University psychologist Christopher Ferguson is especially concerned about a moral panic — a kind of negative overreaction that often follows new trends and technologies.

“Often times, there are these kinds of visceral, negative reactions to new technologies that in some cases lead to pretty extreme claims,” Ferguson said. “It’s not hard to see that in the video game addiction realm, where you see headlines that video games are ‘digital heroin.’ ”

Just consider: Most recently, President Donald Trump suggested that video games may be to blame for mass shootings. There is simply no conclusive evidence to support this claim. But it’s the kind of thing we have seen consistently, from parents calling rock and roll “the devil’s music” to comic book censorship to fears over violent movies .

What is addiction, anyway?

There is still a major divide between the public understanding of addiction and the expert view. It’s common to hear people casually call an activity “addictive” just because it’s fun. Some people continue to see addiction not as a medical condition but as a moral failure, contrary to what major public health and medical organizations have said for decades now . There are still misconceptions that addiction requires some sort of physical component — for example, physical dependence that causes withdrawal — or that physical dependence is conclusive proof of addiction.

Experts, however, have long moved away from these old views of addiction, if they ever held such beliefs at all. Under the expert view, addiction doesn’t even require a physical dependence component.

“We long ago moved away from thinking about addiction as a physical or physiological need for a drug,” Robert West, editor in chief for the scientific journal Addiction , told me. “In most cases, it’s not the physiological [dependence] that’s causing the problem, because you can quite easily get people over that” — through, say, supervised detoxification. “It’s a behavioral problem. Where the problem lies is that certain drugs and behaviors in certain people lead to such powerful motivation to engage in the behavior that it’s damaging or could be damaging.”

It’s that last part of West’s comment that’s key to understanding addiction: It’s when a person compulsively does something even as it leads to negative outcomes, physical dependence or not.

How gaming disorder is defined

The WHO’s designation of gaming disorder, in so many words , essentially fits games into the modern understanding of addiction:

Gaming disorder is characterized by a pattern of persistent or recurrent gaming behavior (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by: 1) impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context); 2) increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and 3) continuation or escalation of gaming despite the occurrence of negative consequences. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The pattern of gaming behavior may be continuous or episodic and recurrent. The gaming behavior and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.

The key consideration here is not any sort of physical symptom. No physical symptoms are mentioned. It’s, again, about compulsive use despite negative consequences. This fits with how other addictions are viewed by experts.

This is not a simple diagnosis. You can’t say that someone is addicted just because he plays games for more than a certain number of hours a week. Experts like Billieux, in fact, strongly cautioned against that kind of interpretation.

“We should not mix high involvement with problematic involvement,” Billieux said. “You can have a high involvement in gaming, if gaming is your main hobby, but you can do it in a totally controlled way that will not have any negative consequences on your daily life.”

“The main thing for me is loss of control — meaning you don’t play when you planned to play, you play more than expected, and you lose voluntary control of the time you spend gaming,” Billieux added. “The other thing is evidenced negative consequences at, for example, the social level, the academic level, professional level, or personal level.”

One commonly cited example is serious sleep deprivation. If someone is consistently losing a lot of sleep over video games, chances are something bad is going on there.

Scott can attest to that. Over time, he got less and less sleep as he stayed up playing games — and it started hurting him throughout his everyday life. “With that small of sleep, my head was a total wreck,” he said. “My memory went to hell.”

That doesn’t mean everyone who loses a bit of sleep to play games or do any other hobby is addicted. But it’s one sign that can be used to try to diagnose if someone has a problem.

A good doctor puts these kinds of data points and anecdotes together to gauge whether someone is addicted to games. Are they losing sleep? Are they failing to attend to major responsibilities like school and work? Are they neglecting family and friends? If you put all of this together, and it looks like someone is consistently putting games above everything else despite negative consequences, then that’s an indication of an addiction.

This applies to other drugs, too. It’s not enough to just use alcohol, marijuana, opioids, or other drugs to be addicted. Even using them a lot isn’t a sign of addiction (although it may be unhealthy for other reasons). Addiction is when someone uses these drugs compulsively despite the damage that follows.

We don’t fully understand why, but some people are more susceptible to addiction than others

So what makes the minority of people with addiction problems different than the majority? Researchers don’t have a conclusive answer to the question, but they say it’s likely a whole host of factors.

Some of it may be other mental health issues. Scott pointed out that his addiction flared up when he felt despair. When he was at his worst with his gaming, he said, “I was feeling really down about life, not sure what to do with myself.” Video games gave him an out, letting him set aside his despair for a little while. Other mental health problems, like anxiety, could play a role too.

It also could be genetic. Some people just experience fewer temptations, or have more willpower, than others. Scientists don’t totally know why. ( Read Vox’s Brian Resnick for more on the science of willpower. )

A person’s environment could play a role too. Maybe video games, particularly free-to-play online games, are the only affordable release at the end of a long workday that a low-income person can find, making it easier for him to get trapped in it. Perhaps someone will be forced to move to a place where she doesn’t have friends, family, or previous hobbies, so games will quickly become the only thing that gives her joy, and soon enough it’s all she does. It could be that, for some people, games are uniquely accessible, making them easy to play too much — as was true in Scott’s case, working from home.

And it could be all of these things combined or something else entirely. No one knows for sure, whether for gaming addiction or other forms of addiction.

Video games involve unique risks for addiction

There are also factors that might make games uniquely risky compared to other activities, making it more likely that someone will become addicted to them and play far too much.

One is easy access.

Billieux cited a patient who compared the rush he gets playing Fortnite , a very popular online multiplayer game, to his experiences skydiving. That may sound hard to believe (especially if you, like me, find Fortnite extremely boring), but it’s this person’s genuine impression of the game.

Consider what that means for this person. In the past, he would have had to take several steps, from booking a plane to physical travel, to get the rush he got from skydiving. Now, he just needs to turn on whatever device he plays Fortnite on and immediately get that same rush.

And Fortnite is on every single gaming device, including phones. So someone can play Fortnite literally all the time, certainly far more than they can go skydiving.

Scott pointed out that this was a big problem from him: Working from home, he was always a few clicks away from games, and that made it easy to misuse them.

In contrast, Scott still plays poker and card games — but now he does it face-to-face, not over the computer. Even if he wanted to, it would be difficult for him to overdo these real-life activities, because they require physical travel and, since he plays with friends, setting up a time and place with other people. As Scott told me, “I can’t just play poker face-to-face whenever I want.”

Another issue is the possibility of immersion. In games, you don’t just follow the stories and actions of certain characters; you are the characters. In roleplaying games like World of Warcraft , you can spend hundreds, if not thousands, of hours building a character — going through a story you feel like you’re a part of, taking on challenges, and building a reputation for yourself among other gamers. This can be further compounded if a game, like World of Warcraft , has an online multiplayer element, compounding the immersion with socialization with other players.

Other forms of entertainment, like books and movies, can be immersive, but they simply don’t put the audience in the middle of a fantasy world like a game can.

Increasingly, some other games are also adopting gambling mechanics, which introduces a whole new layer of addiction. One example is loot boxes, which players buy within games with in-game currency or real money for a chance at exclusive or powerful items.

But there are other gambling-like mechanics in games, from a random chance at a powerful reward for completing certain repeatable challenges to literal in-game casinos with virtual slot machines, that can entice a person to keep playing for far longer than she would otherwise.

Still, even with these mechanics, only a small fraction of gamers get addicted, based on the evidence.

Video games can do a lot of good, too

Part of the concern here is that stifling video games could substantively harm people. Games are now used in education all the time. Some places, like Radboud University’s Games for Emotional and Mental Health Lab in the Netherlands, are now studying the use of video games for therapy. There’s even some early research into “prescription video games,” trying to see how games — especially with the advent of virtual reality — could be used to help treat mental health conditions.

But beyond a medical setting, video games entertain people. They can let people relax after a hard day. They can provide an escape. All of these are real benefits that help people on a daily basis.

With the news of the WHO’s designation earlier this year, I began to think about my own gaming, particularly back when I was in high school. I spent a lot of time playing World of Warcraft — 40 hours a week, if not more.

I did not have the problems that Scott did. I got mostly A’s in high school, went to college and studied journalism, went to parties, hung out with friends on weekends, and spent time with my family.

In fact, looking back, I still think World of Warcraft was good for me. As a closeted gay teen, it was the one space where I found a group of friends I could be totally open with. I came out to them long before I came out to anyone I knew in my real life. (Often hearing remarks at my school like, “It’s Adam and Eve, not Adam and Steve,” certainly did not help me come out there.) Having a safe space online made my early gay life a lot more bearable.

And video games, from World of Warcraft to Super Smash Bros ., were one of the things that helped bring my husband and me together. It’s still something we do together on a daily basis. So games have helped my later gay life, too.

For the vast majority of the billions of people playing games, this is true as well: Games are a form of entertainment, not a problem to be solved.

From the causes to the solutions, both sides say we need a lot more research into gaming addiction

As gaming addiction continues to capture more attention from the media and public health organizations, one of the big obstacles to identifying and detecting — much less preventing and treating — the problem is that the research in this area remains scarce, from even basic issues like how to define gaming addiction to more complex problems like how to treat it.

A thorough review of the research , published in Psychiatry and Clinical Neurosciences in 2017, found evidence that “pathological gaming symptoms” and game addiction, but not gaming in general, were associated with negative health and social consequences, such as depression and worse academic achievement, in one- or two-year follow-ups.

But the review also described the research into the detection and prevention of gaming addiction as “obviously insufficient,” and studies on the natural course of gaming addiction as “limited” — confirming major gaps in the field.

Michelle Colder Carras, a public health researcher now at Radboud University’s Games for Emotional and Mental Health Lab in the Netherlands, joined dozens of other experts to write a letter and follow-up to the WHO arguing against the addition of gaming disorder to the ICD-11. The authors wrote, “The quality of the research base is low. The field is fraught with multiple controversies and confusions and there is, in fact, no consensus position among scholars.”

It’s not that excessive gaming can’t ever be a serious problem, Colder Carras told me. But “excessive gaming, even when we feel it’s causing problems, we don’t feel like we have enough evidence to determine that it’s worthy of making it into a disorder.”

One example, according to Colder Carras: A lot of the evidence uses criteria typical for drug and gambling addiction to measure the prevalence and harms of gaming addiction. But there are obvious differences between these types of addiction. For example, a potential sign that someone is addicted to drugs or gambling is consistent use to improve mood. If someone does that with games, though, it’s not necessarily bad — just about every hobby is, to some extent, about improving a person’s mood.

The research on treatment of gaming addiction is even weaker. There are no large-scale randomized controlled trials (the gold standard of research) looking at different kinds of care for gaming addiction.

“The evidence is strong in relation to the negative consequences,” Billieux, of the University of Luxembourg, said, noting that more people are actively seeking treatment for gaming addiction. “It’s less strong regarding evidence-based treatment.”

For now, researchers are largely applying approaches proven to work in other areas of mental health and addiction, particularly cognitive behavioral therapy and motivational interviewing, to patients that come in with gaming addiction.

“The most evidence we have is for the substance use disorders,” Petros Levounis, chair of the Department of Psychiatry at Rutgers New Jersey Medical School, told me. “Then comes gambling disorder. Then it’s internet gaming disorder. Then I would put pretty much all the rest of the behavioral addictions.”

So there’s still some conflict in the research world to be ironed out over time.

For people like Scott, though, gaming addiction is very real now — and quitting games was life-changing for the better. “I’m very grateful to be mentally present when I’m with my son,” he said, “and to not struggle with the feeling that he and video gaming are competing for my time.”

Will you support Vox today?

We believe that everyone deserves to understand the world that they live in. That kind of knowledge helps create better citizens, neighbors, friends, parents, and stewards of this planet. Producing deeply researched, explanatory journalism takes resources. You can support this mission by making a financial gift to Vox today. Will you join us?

We accept credit card, Apple Pay, and Google Pay. You can also contribute via

The failed promise of egg freezing

We could be heading into the hottest summer of our lives, the unexpected joy of the squirrel census, sign up for the newsletter today, explained, thanks for signing up.

Check your inbox for a welcome email.

Oops. Something went wrong. Please enter a valid email and try again.

Change Password

Your password must have 6 characters or more:.

• a lower case character, 
• an upper case character, 
• a special character 

Password Changed Successfully

Your password has been changed

Create your account

Forget yout password.

Enter your email address below and we will send you the reset instructions

If the address matches an existing account you will receive an email with instructions to reset your password

Forgot your Username?

Enter your email address below and we will send you your username

If the address matches an existing account you will receive an email with instructions to retrieve your username

• April 01, 2024 | VOL. 181, NO. 4 CURRENT ISSUE pp.255-346
• March 01, 2024 | VOL. 181, NO. 3 pp.171-254
• February 01, 2024 | VOL. 181, NO. 2 pp.83-170
• January 01, 2024 | VOL. 181, NO. 1 pp.1-82

The American Psychiatric Association (APA) has updated its Privacy Policy and Terms of Use , including with new information specifically addressed to individuals in the European Economic Area. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences.

Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

Internet Gaming Addiction: Disorder or Moral Panic?

• Patrick M. Markey , Ph.D. ,
• Christopher J. Ferguson , Ph.D.

Search for more papers by this author

As researchers (and parents), we often hear other parents complain that their children are “addicted” to video games. They will note, with concern, that their child spends too much time playing Call of Duty or logged onto the Xbox and not enough time outside. Although some scholars acknowledge the potential for some video game players to engage in pathological use ( 1 – 4 ), many have expressed concern that video games are currently in a cycle of “moral panic” common to all new media, and the potential for exaggeration of a real but uncommon problem should be carefully guarded against ( 5 – 9 ). Perhaps with these cautionary notes in mind, the American Psychiatric Association has thus far taken a conservative approach to proposing specific new diagnoses for Internet gaming disorder in DSM-5 ( 10 ). To address the validity of this proposed diagnostic category, Przybylski et al. ( 11 ), in this issue of the Journal , present the first large-scale preregistered study that examines Internet gaming disorder diagnostic criteria, prevalence, and relationship with social, physical, and mental health.

In this research, almost 19,000 participants from the United States, the United Kingdom, Canada, and Germany completed a checklist of symptoms that can be used to diagnose Internet gaming disorder. These items represent the nine symptoms proposed by DSM-5 to diagnose symptoms of this disorder: preoccupation (spent too much time thinking about games), withdrawal (felt moody or anxious when unable to play), tolerance (increased playtime to keep excitement high), inability to reduce playing (felt that I should play less but could not), give up other activities (reduced or lost interest in other activities), continue despite problems (kept playing even though it caused problems), deceive (keep others from knowing how much I play), escape mood (played to escape uncomfortable feelings), and risk (risked friends or opportunities due to games). Using DSM-5 recommendations, participants were diagnosed with Internet gaming disorder if they endorsed five or more of the symptoms.

One important assumption clinicians and researchers make when using such a list of symptoms to make a diagnosis is that these symptoms equally contribute toward the diagnosis. This might at first appear problematic when one examines the items used to diagnosis this disorder. For example, it seems to make sense that individuals who lose their job or personal relationship because they cannot stop playing a video game (i.e., continue despite problems) might have an issue with this media. However, this appears to be fundamentally different from a person who plays a game after having a tough day at work (i.e., escape mood) or who gives up other activities to play video games (i.e., give up other activities). Such items seem to relate to just about any hobby a person might enjoy. To test the assumption that all items equally contribute toward the same construct, these scholars applied a factor model with equal factor loadings and dichotomous outcomes. Impressively, this Rasch model fit the data extremely well. Furthermore, equal factor loadings were also found across gender and across different countries. Such findings suggest that the list of behaviors employed by Przybylski et al. possess good psychometric properties. In effect, there is evidence that they measure the same basic construct. But is this construct indicative of pathology?

One reason it is important to find a “gold standard” for diagnosing Internet gaming disorder is because, to date, there have been at least 18 different ways researchers have operationalized Internet gaming disorder ( 12 ). This is problematic because these different methodologies have produced prevalence rates of Internet gaming disorder ranging from almost zero to a high of 45%. However, even with all this variability in prevalence rates, one recent meta-analysis found that most studies seem to suggest that around 3% of people who play video games are at risk for developing this disorder ( 13 ).

Given that the majority of participants in the Przybylski et al. study had recently played an Internet-based video game, it was somewhat surprising that approximately 65% reported that they had no symptoms associated with Internet gaming disorder. Similar to what was found in the previous meta-analysis (3.1%) ( 13 ), 2.4% of the sample endorsed at least five behaviors used by the DSM to indicate problematic gaming. However, those who also reported feelings of distress due to gaming accounted for only between 0.3% and 1% of the sample. Using the same sample, these scholars were able to compare the prevalence rates of Internet gaming disorder to the only other behavioral addiction in the DSM, gambling. Findings indicated that the prevalence of Internet gaming disorder was lower among people who played a video game in the last year than the prevalence of gambling disorder among people who had engaged in any form of gambling in the past year.

These results seem to indicate that Internet gaming disorder has an extremely low period prevalence rate (less than 1%) and is less likely to be expressed by gamers than a gambling disorder is to be expressed by a gambler. Of course, this does not necessarily mean that it is not an important condition to consider. Fortunately, Przybylski et al. also assessed the clinical impact of Internet gaming disorder by measuring participants’ mental, physical, and social health. Contrary to the popular belief that Internet gaming disorder is related to poorer health, this large-scale study found that those meeting the criteria for diagnosis of Internet gaming disorder did not display any differences in terms of behavioral or clinical effects. In fact, the biggest difference found was that those who were diagnosed as having the disorder simply played more video games than other individuals.

Arguably, findings from this study suggest that the currently used symptoms of Internet gaming disorder employed by DSM-5's proposed category are neither sensitive to nor specific to actual pathology. Although prevalence rates of individuals endorsing the Internet gaming disorder criteria were very low, they were still far higher than those experiencing distress or other problems, suggesting a high type I error rate for the proposed category. Or put simply, Internet gaming disorder continues to risk pathologizing normal behaviors given the inclusion of too many “symptoms” that do not indicate pathology.

It further remains unclear why the DSM-5 includes Internet gaming disorder as a proposed category, but not other behaviors (sex, work, exercise, eating, etc.), which may be “addictive.” Current data suggest that the proposed Internet gaming disorder category is a poor indicator of actual problems. Therefore, its use in clinical settings, as presently delineated, may ultimately cause more harm than good.

This important study suggests that video game addiction might be a real thing, but it is not the epidemic that some have made it out to be. Nor is it comparable to addiction to alcohol, methamphetamines, or even gambling. Although many people incorrectly blame video games for producing problems in people’s lives, this study suggests that having Internet gaming disorder, at least using the DSM’s current symptomology, is not related to having psychological, social, or physical health issues. For almost all kids and young adults, video games will be a normal part of their development. The overwhelming majority of people appear to be able to play video games while still balancing a productive work schedule and active social life.

The authors report no financial relationships with commercial interests.

1. Block JJ : Issues for DSM-V: internet addiction . Am J Psychiatry 2008 ; 165:306–307 Link ,  Google Scholar

2. Desai RA, Krishnan-Sarin S, Cavallo D, et al. : Video-gaming among high school students: health correlates, gender differences, and problematic gaming . Pediatrics 2010 ; 126:e1414–e1424 Crossref , Medline ,  Google Scholar

3. Griffiths MD : Videogame addiction: further thoughts and observations . Int J Ment Health Addict 2008 ; 6:182–185 Crossref ,  Google Scholar

4. Van Rooij AJ, Meerkerk GJ, Schoenmakers TM, et al. : Video game addiction and social responsibility . Addict Res Theory 2010 ; 18:489–493 Crossref ,  Google Scholar

5. Barnett J, Coulson M : Virtually real: a psychological perspective on massively multiplayer online games . Rev Gen Psychol 2010 ; 14:167 Crossref ,  Google Scholar

6. Ferguson CJ : Blazing angels or resident evil? Can violent video games be a force for good? Rev Gen Psychol 2010 ; 14:68 Crossref ,  Google Scholar

7. Kardefelt-Winther D : A critical account of DSM-5 criteria for Internet gaming disorder . Addict Res Theory 2015 ; 23:93–98 Crossref ,  Google Scholar

8. Markey PM, Males MA, French JE, et al. : Lessons from Markey et al. (2015) and Bushman et al. (2015): Sensationalism and integrity in media research . Hum Commun Res 2015 ; 41:184–203 Crossref ,  Google Scholar

9. Olson CK : Children’s motivations for video game play in the context of normal development . Rev Gen Psychol 2010 ; 14:180 Crossref ,  Google Scholar

10. American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders , 5th ed. Washington DC, American Psychiatric Publishing, 2013 Crossref ,  Google Scholar

11. Przybylski AK, Weinstein N, Murayama K : Internet gaming disorder: investigating the clinical relevance of a new phenomenon . Am J Psychiatry 2017 ; 174:230–236 Link ,  Google Scholar

12. King DL, Haagsma MC, Delfabbro PH, et al. : Toward a consensus definition of pathological video-gaming: a systematic review of psychometric assessment tools . Clin Psychol Rev 2013 ; 33:331–342 Crossref , Medline ,  Google Scholar

13. Ferguson CJ, Coulson M, Barnett J : A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems . J Psychiatr Res 2011 ; 45:1573–1578 Crossref , Medline ,  Google Scholar

• Are CBT-based interventions effective for pathologic technology use? A meta-analysis of experimental studies 27 September 2023 | Current Psychology, Vol. 43, No. 12
• Gaming disorder and stigma‐related judgements of gaming individuals: An online randomized controlled trial 10 May 2023 | Addiction, Vol. 118, No. 9
• Self-determination theory approach to understanding the impact of videogames on wellbeing during COVID-19 restrictions 1 July 2022 | Behaviour & Information Technology, Vol. 42, No. 11
• Development and validation of Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) for Internet Gaming Disorder (IGD) and factor analytic assessment Psychiatry Research, Vol. 324
• A Meta-Analysis of Factors Predicting Parental Mediation of Children’s Media Use Based on Studies Published Between 1992–2019 12 April 2023 | Journal of Child and Family Studies, Vol. 32, No. 5
• Gaming disorder: A summary of its characteristics and aetiology Comprehensive Psychiatry, Vol. 122
• Emotions Studied by Computer Scientists and Psychologists — A Complementary Perspective
• Perceived economic discrimination and problematic internet use among Chinese adolescents: The mediating role of self-esteem and the moderating role of school connectedness 17 May 2021 | Current Psychology, Vol. 42, No. 6
• Digital games and literacies
• Internet Gaming Disorder and Addictive Behaviors Online 16 March 2023
• Taking a Dialogical Approach to Guiding Gaming Practices in a Non-Family Context 28 December 2022 | Media and Communication, Vol. 10, No. 4
• Exploring Internet gaming disorder: an updated perspective of empirical evidence (from 2016 to 2021) Comprehensive Psychiatry, Vol. 116
• Emerging experience with selected new categories in the ICD ‐11: complex PTSD , prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder 7 May 2022 | World Psychiatry, Vol. 21, No. 2
• Infamous Gaming: The Intergroup Bias of Non-gamers in the Chinese Marriage Market 7 February 2022 | Frontiers in Psychology, Vol. 13
• Learning from Video Games (and Everything Else) 1 December 2021 | , Vol. 11
• Development of a Game Communities of Inquiry Scale (GCoIS)
• Digital Games and Mental Health
• Evaluating U.S. gamers’ metacognitions about digital entertainment: Validation of Metacognition about Online Gaming Scale in the U.S. context Journal of Affective Disorders, Vol. 295
• Stigma‐related arguments against gaming disorder: a call for research 16 May 2021 | Addiction, Vol. 116, No. 10
• Identification of internet gaming disorder individuals based on ventral tegmental area resting-state functional connectivity 10 October 2020 | Brain Imaging and Behavior, Vol. 15, No. 4
• Prevention approaches to problem gaming: A large-scale qualitative investigation Computers in Human Behavior, Vol. 115
• Playing across the social zone - Animal Crossing, gaming communities and connectedness in a time of crisis. Academicus International Scientific Journal, Vol. 23
• Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria Journal of Behavioral Addictions, Vol. 9, No. 3
• A Computational Approach to Analyzing the Twitter Debate on Gaming Disorder 13 August 2020 | Media and Communication, Vol. 8, No. 3
• Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11 21 October 2019 | Australian & New Zealand Journal of Psychiatry, Vol. 54, No. 7
• Youth Internet Safety Education: Aligning Programs With the Evidence Base 3 April 2020 | Trauma, Violence, & Abuse, Vol. 6
• Altered neural processing of negative stimuli in people with internet gaming disorder: fMRI evidence from the comparison with recreational game users Journal of Affective Disorders, Vol. 264
• Ethical Dimensions of Digital Games 30 November 2020
• Brain Imaging and Behavior, Vol. 13, No. 4
• 网络游戏成瘾研究的争议及趋势 13 July 2022 | Advances in Psychological Science, Vol. 27, No. 1
• Addictive Behaviors, Vol. 82
• Computers & Education, Vol. 122
• PLOS ONE, Vol. 13, No. 11

• internet gaming disorder
• video games

• International edition
• Australia edition
• Europe edition

'It consumed my life': inside a gaming addiction treatment centre

As the World Health Organization classifies gaming disorder as a mental health condition, one UK treatment centre reveals how it is trying to tackle the problem

I an* was in his 20s when he started gaming in the mid-1990s. A long-time interest in building PCs had developed into an initially healthy interest in first-person shooters like Counter Strike and Team Fortress, which he’d play at weekends and when he came home from work.

It was the online element of these games, he says, that really changed his relationship to gaming, and what started as a hobby quickly took over his life.

“I was working, I had a family, so it was a slow progression,” he says. “But then – and it sounds really weird when I say it now – I started thinking about it at work, and the first thing I’d do when I got home was start drinking and start up the internet and game.”

Video games are enjoyed by millions of people around the world without any harmful effects whatsoever. Most players will never have to worry about it becoming a problem. But for a small number of people, what starts out as a fun hobby becomes a debilitating habit. Though behavioural addictions like gaming, gambling or sex can be less physically debilitating than similar addictions to drugs or alcohol, their impact can be no less severe. Ian recalls setting up a computer in his dining room, where he’d play until midnight every night – the time his dial-up connection finished – often using drugs and alcohol to allow him to keep gaming.

“Every night up until that time I would play,” he says. “When I got home on a Friday night, I would sit at the computer and I wouldn’t leave until Sunday night. I would use amphetamines to stay awake and just game continuously, and I would only leave the computer to go to the toilet. It just consumed my life.”

Ian’s addiction to gaming got so bad that, eventually, he ended up losing his family and job. “I just wasn’t there – I was there in body in the house, but I wasn’t looking after my children,” he says. “I wasn’t there for them.”

Though often sensationalised by a tabloid press keen to put the boot into the latest gaming fad, gaming addiction is a real and growing problem. The World Health Organization has listed and defined gaming disorder as a condition warranting further research in the 11th edition of International Classification of Diseases (ICD-11), citing an increase in the development of treatment programmes across the world – something that has already started happening in the UK.

One centre providing such treatment is Primrose Lodge , an addiction centre set in quiet, leafy countryside just outside Guildford. Staff there say they have seen a recent increase in patients seeking help for gaming addiction.

“It’s really happened over the last 12 months or so,” senior therapist Matthew Preece tells me.

Preece runs one-to-one and group sessions with patients at the centre, with a focus on techniques taken from dialectical behavioural therapy (DBT).

“The key element of DBT is that it’s based on mindfulness practice,” Preece explains. “We’re talking about relapse prevention here – the person being able to maintain their emotional regulation, being able to recognise emotions, and challenging existing thoughts and behaviours.”

Other techniques include exercises to help change physical sensations and manage compulsive behaviours – something that could be as simple as a focused, structured breathing exercise, or plunging your hands into cold water – and processes to help people with confrontation, dialogue and communication.

Spotting the difference between obsession and addiction can be hard, Preece says, especially when it comes to gaming. Someone with a gambling addiction, he suggests, may be more easily able to tell that they had a problem, because they might be losing tens of thousands of pounds. When someone has a gaming addiction, however, “the consequences are more subtle”. Millions of people enthusiastically play games – and despite media scrutiny of popular games like Fortnite or Call of Duty, the vast majority of them are not addicted in any real sense.

It’s when gaming “starts to be of detriment to other areas of someone’s life – their work, relationship, their self-care,” that it becomes a problem, Preece says. “If someone tries to cut down, and they find they can’t control that, or if they start to be secretive or dishonest about their behaviour – they’re kind of the main things to look out for.”

We still don’t know exactly what the basis for gaming addiction is, explains Pete Etchells, lecturer in biological psychology at Bath Spa University. “There’s a lot of debate and argument in the research literature about this,” he says. “There’s a lot of uncertainty around whether it’s best to frame it as something akin to a substance abuse disorder, or whether it’s best looked at in terms of something like an impulse control behaviour.”

“There’s also the wider question of whether gaming disorder is an actual disorder in and of itself, or whether it masks other underlying disorders. So, say you have a person with signs of clinical depression who uses gaming as a coping mechanism – it might look as though they have a gaming addiction. But actually, it’s the underlying depression that probably needs to be treated.”

The problem is not purely psychological, either, adding another element to the debate.

“All games need a hook,” Adam Procter, programme leader of the Games Design and Art BA course at the University of Southampton, says. Designers – somewhat obviously – focus on mechanisms that draw players in, he explains, something that “often involves a level of replayability”.

This could be something as simple as a leaderboard – where you can compare your gameplay with friends – or as varied as purchasable in-game content that allows you to enhance your character or make changes to the game experiences. This could come in the form of a loot box – where you don’t know what kind of content you might end up with – or in the form of specific purchases.

Research confirms this: one pilot study in 2013 found that specific features of games were associated with “problematic behaviours associated with addiction-like experiences”. Games providing increasing rewards – earning points or finding rare items, for example – or games with a “high social component”, where players were likely to play and share tips and strategies with others, had a significant association with addictive behaviour. These kinds of mechanisms are built into games – something Procter compares to Sean Parker’s statement that his team at Facebook constantly asked themselves: “How do we consume as much of your time and conscious attention as possible?”.

This kind of functionality was pivotal in Ian’s addiction – he specifies purchasable skins and character upgrades and leaderboards as part of his obsession – and has been frequently cited as problematic elsewhere. Loot boxes in particular, which work much like gambling, have been described as “ predatory ”, with the Belgian Gaming Commission even going so far as banning them .

So, with a growing awareness of gaming disorder, do designers have a responsibility to prevent or curtail addiction?

Preece thinks so. “There needs to be a responsibility,” he says. “They’re deliberately tapping into an addictive process ... so yes, I would like to see more responsibility around that.”

Procter says that game makers “should be aware that the product they’re making will have an impact on players”, and that “there will always be a responsibility for makers to consider their impact on the world”.

“As designers, we should recognise this rise in games addiction, and have an open discussion about industry wide safeguards along with parent education,” he says.

Ian, now in recovery from his addiction and rebuilding his life, hopes that the ICD listing of the disorder will raise awareness of the issue – and educate people on something that they currently don’t understand.

“People look down on it. They don’t think of it as serious,” he says. “But it’s the same as gambling, alcohol, drugs, or any other addiction. It can be very dangerous, very harmful, and very destructive.”

* Name has been changed

• Mental health
• World Health Organization
• Game culture

Comments (…)

Most viewed.

When A Video Game Becomes An Addiction

ORIGINAL RESEARCH article

Video game addiction and emotional states: possible confusion between pleasure and happiness.

• 1 Research Center for Work and Consumer Psychology, Université Libre de Bruxelles, Brussels, Belgium
• 2 Department of Psychiatry and Neurosciences, Maastricht University, Maastricht, Netherlands

Internet gaming disorder is characterized by a severely reduced control over gaming, resulting in an increasing gaming time and leading to negative consequences in many aspects of the individual life: personal, family, social, occupational and other relevant areas of functioning (World Health Organization). In the last years, the significant boom in using video games has been raising health issues that remain insufficiently understood. The extent of this phenomenon (the estimated prevalence is between 1.7 and 10% of the general population) has led the mentioned Organization to include gaming disorders in the list of mental health conditions (2018). Several studies show converging findings that highlight the common brain activities between substance use disorders and behavioral addictions (i.e., gaming disorders). Addiction specialists observed that addict subjects tend to confuse pleasure with happiness when linking emotional states to their addictive activities. As far as we know, beyond the mentioned observations, distinguishing the perception of these two emotional states in the frame of an addiction has not been yet the object of formal research. This study aims at examining the possible confusion between pleasure and happiness within the addiction sphere. Video game addiction has been chosen to explore the possible occurrence of this perceptional distortion. A mixed design lab-based study was carried out to compare between video games addicts and non-addicts (between-subjects), and video games-related activities and neutral activities (within-subject). Emotional reactions were gauged by self-reported scales and physiological data acquired through a range of biosensors: Relaxation and Hearth Rate. From a therapeutic standpoint, this research intends to explore alternatives to deal with this sort of disorders. More specifically, at the cognitive level, the idea is elaborating guidelines to develop patients’ insights into these emotional states and thus increasing their ability to handle them. Overall, several indices resulting from this study constitute a bundle of arguments that argue in favor of the confusion between pleasure and happiness made by addict users when associating their affective states to video gaming. Furthermore, this approach illustrates how reappraising emotions may contribute to reducing the perceptional distortion of these emotional states.

Introduction

In the last years, the significant boom in using video games (VG) has been raising health issues that remain insufficiently understood ( Khazaal et al., 2016 ). The World Health Organization [WHO] (2018) has recently included “gaming disorders” in the list of mental health conditions. According to WHO this affliction is a “persistent or recurrent behavior pattern of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) considers the ‘Internet Gaming Disorder’ as a potential new diagnosis that requires further research ( Petry et al., 2015 ). The prevalence of problematic gaming is estimated to range from 1.7% to over 10% among general population ( Griffiths et al., 2012 ).

Compared to the core topics of research in neuroscience such as stress, depression, etc., the chronic use of VG is a rather recent field of investigation. Yet, a growing number of studies have been produced in this field in the last two decades ( Andreassen et al., 2016 ). Indeed, several research projects have been exploring VG addiction from a behavioral, emotional, brain circuits and genetic perspectives ( Griffiths et al., 2012 ; Dong et al., 2017 ).

There seems to be converging findings that highlight the common brain activities between VG disorders (belonging to the cluster of behavioral addictions) and substance use disorders (SUD). It has been shown that the dorsolateral prefrontal cortex, orbital frontal cortex, para-hippocampal gyrus and thalamus were activated in both disorders ( Han et al., 2011 ). The limbic structures appear to be the key circuits linked with reward and addiction ( Cooper et al., 2017 ). In subjects suffering from these disorders, cues associated with SUD and with behavioral addiction can trigger craving, which is connected with the dopamine reward system ( Ko et al., 2009 ; Han et al., 2011 ). In addition, it has been observed that the level of dopamine released in the ventral striatum when playing a competition like video game is comparable to that provoked by psycho-stimulant drugs ( Koepp et al., 1998 ; Yau et al., 2012 ). Few studies have been carried out on the genetic aspects of this topic. Some of them indicate that there would be genetic background similarities between these two disorders. For example, the homozygous short allelic variant of the 5HTTLPR gene (encoding the serotonin transporter) is more prevalent among the excessive Internet user, which is also linked with increased drug consumption ( Serretti et al., 2006 , as cited in Yau et al., 2012 ; Lee et al., 2008 , as cited in Yau et al., 2012 ).

As described later, studying the confusion between pleasure and happiness in the frame of addiction requires as clear a demarcation as possible between these two emotional states. Although a consensus among scientists on how to define and distinguish pleasure and happiness remains to be reached (see next section Pleasure and Happiness ), in this research we have adopted the following distinctive traits to describe and to work with these two emotional states: pleasure relates to a transient emotional state resulting from the satisfaction of a desire, a craving, and happiness refers to a lasting emotional state of contentment, euthymia ( Pollard, 2003 ; Lustig, 2017 ).

According to Lustig (2017) , addictions together with depression are two rampant afflictions in the last decades and constitute the harmful extremes of pleasure (associated with the dopaminergic system) and happiness (associated with the serotoninergic system) respectively ( Üstün et al., 2004 ; Lepine and Briley, 2011 ; Szalavitz, 2011 ; Whiteford et al., 2013 ; Gowing et al., 2015 ; Keyes et al., 2015 ). Based on his long practice on addiction issues, this author argues that confusing pleasure (in the sense of longing, craving, strongly driven by a short term reward) with happiness is linked with SUD and with behavioral addictions (i.e., gambling, eating disorders, excessive use of technology like for example social media and VG, etc.), which could lead to depression ( Lawrence et al., 2014 ). According to the author, confusing pleasure with happiness is related to the growth rate of this disorder insofar as it would encourage seeking immediate gratifications perceived as sources of happiness, which in turn triggers the reward system with the risk to sink into the vicious circle of addiction ( Pollard, 2003 ). Besides, the significant industrial development, through its commercial campaigns, probably tended to lead individuals to equate consumption with happiness ( Schmidt, 2016 ; Lustig, 2017 ). From a physiological standpoint, the author highlights that an over excited reward system engenders an excess of dopamine (DA) release from the ventral tegmental area, which in return decreases serotonin (5HT) level (associated with depression) ( Pollard, 2003 ; MacNicol, 2016 ).

Moreover, Lustig underlines that DA and 5HT amino acids (needed for the production of DA and 5HT) share the amino acid transporters, which poses a problem in case of DA amino acid over presence: that is to say, the more amino acids for DA, the less amino acids transporters are available for 5HT amino acids. In short, this DA-5HT unbalance illustrates one of the facets of the DA-5HT interaction in which the low 5HT level, associated with depression, prevents the serotoninergic system to exert its inhibitory role to imped the over drive of the dopaminergic system ( Esposito et al., 2008 ).

Chronic stress and anxiety may further aggravate this problem by increasing the cortisol level and thus creating a loop with dopamine activating the sympathetic nerve system and reinforcing the reward seeking behavior while down-regulating 5HT -1a receptor, which decreases the serotonin signaling and increases the depression likelihood ( Lustig, 2017 ). These findings are in line with studies that associate stress, anxiety and depression with Internet gaming disorders ( Wenzel et al., 2009 ; Griffiths et al., 2012 ).

Fundamentally, from a phylogenetic standpoint, it is likely that pleasure has contributed more than happiness ( Pollard, 2003 ; Lustig, 2017 ), which could explain the stronger drive of the short term gratifications over the quest for medium and long term euthymia. In sum, this suggests that identifying the possible confusion between the mentioned emotional states associated with the addictive activities may contribute to deepen the understanding of this sort of disorders and consequently to explore new therapeutic options.

The emotional states (and their consequences) associated with VG as felt and perceived by chronic users led to thorough interrogations of health professionals. Several studies intended to explore this issue by focusing on the individual characteristics of addict players. For instance, the general level of happiness appears to be a firm candidate to predict addiction to VG playing ( Hull et al., 2013 ). In effect, it has been shown that gaming disorders are positively correlated with depression and loneliness and negatively correlated with well-being ( Lemmens et al., 2011 ; Sarda et al., 2016 ). These two studies relied on a eudaimonic notion of well-being (i.e., life satisfaction, a life well lived). Thus, based on the mentioned definitions of pleasure and happiness, on the semantic net (see Annex ) and on the analysis made in the next section (Pleasure and Happiness), in this research well-being is assimilated to happiness due to the considerable common ground shared between these two concepts. In line with these findings, another study highlights the association between high frequency of online gaming with depression and social phobia ( Wei et al., 2012 ). Similar results were found in a study in which, compared with no addict Internet user, Internet addict subjects used to play online games reported significantly more depressive symptoms ( Geisel et al., 2015 ).

From a psychological symptoms standpoint, it has also been observed that when playing VG, addict gamers have a sense of well being or euphoria while playing VG, inability to stop the activity, craving more time at playing VG, feeling empty, depressed, irritable when not playing VG, with all the pernicious consequences these symptoms have on the private, social and professional life ( Griffiths, 2008 ). At glance, the coexistence of well being and craving might come across as paradoxical, although the mentioned work ( Lustig, 2017 ) on this issue provides some elements of answer to this finding.

Using a video game clip as a stimulation trial, it has been studied ( Kim et al., 2018 ) the craving state of chronic users when playing VG through measures resulting from addiction questionnaires and several bio signals such as eye blinking, eye saccadic movements, skin conductance and respiratory rate. The results of this work showed that during the stimulation trial video game there was a decrease of eye blinking rate, eye saccadic movement rate and mean amplitude of the skin conductance response whereas there was a significant increase of the mean respiratory rate.

Another study ( Lu et al., 2010 ; as cited in Kim et al., 2018 ) focused on a group of individuals with high risks of developing Internet gaming disorders (IGD) and their sympathetic nervous system responses. When using Internet in this experiment, increases were observed in blood volume, body temperature and respiratory rate. Heart rate (HR) has also been used as a reliable indicator of craving in subjects with SUD ( Kennedy et al., 2015 ).

Pleasure and Happiness

The psychophysiological and brain mechanisms of pleasure and happiness are quite complex and probably more research is required to better discerning these processes. Some studies have underlined that the hedonic system includes wanting and liking and each of these two emotional states may operate in a conscious and unconscious mode ( Berridge and Kringelbach, 2011 ). Studies indicate that unconscious wanting would function as a conditioned desire involving the nucleus accumbens, ventral tegmental area, hypothalamus and dopamine; on the other hand the unconscious liking would relate to a sensory hedonic dimension associated with the nucleus accumbens, ventral pallidum, periaqueductal gray, amygdala, opioids and cannabinoids ( Kringelbach and Berridge, 2009 ; Berridge and Kringelbach, 2013 ). The same studies show that conscious wanting would relate to cognitive incentives, subjective desires and dopamine whereas conscious liking would be linked with subjective pleasures, opioids and cannabinoids; both would involve the orbitofrontal cortex, anterior cingulate and insular.

It has been shown that the level of activation of some of the mentioned areas would be altered in subjects with Internet gaming disorders: sensing craving for gaming is associated with an increased activation of the left orbitofrontal cortex (correlated with desire for VG play) and with a decreased activation in the anterior cingulate cortex (probably linked with the reduced capacity to inhibit craving for gaming) ( Wang et al., 2017 ).

There might be a relation between the complexity of these brain circuits linked to these emotional states and the polysemy of these two terms, happiness and pleasure , which may contribute to the possible confusion between them. Indeed, the intense interrelation between them finds expression in subtle distinctive features and in some connotations with vague borders, to the extent that these words might be regarded as almost synonyms. The semantic analysis of these two terms produced in this research intends to show their core meanings, their nuances and the possible intersections between them ( Procter, 1985 ). Trying to unravel and to understand these two emotional states is not a recent endeavor. For instance, Greek thinkers approached the notion of happiness as a state constituted by two components: Hedonia (pleasure) and Eudaimonia (a life well lived) ( Kringelbach and Berridge, 2009 ).

Due to its nature, defining and studying happiness is a quite uneasy task. Although progress has been made on this rather recent area of study, there is still a lack of consensus when it comes to defining this concept. Some authors distinguish fluctuating happiness (self centered) from durable, authentic happiness (self-transcendent) ( Dambrun et al., 2012 ). Another study uses the value-arousal model on emotions to define it, according to which happiness results from a positive valence, high arousal and engaged and satisfied in life ( Cipresso et al., 2014 ). Lustig (2017) emphasizes the time perspective as one of the distinguishing traits between these two emotional states by opposing the short-term logic of pleasure to the longer-term characteristics of happiness .

These last two studies are quite illustrative of the differences with regard to defining happiness , in particular when it comes to including or not pleasure in it. Whilst there seems to be a consensus on “life satisfaction,” “connecting with others” and “contentment” as the main traits of happiness , it is less clear whether pleasure is part of it. Usually, in the literature there are two understandings to articulate these emotional states: either both ( happiness and pleasure) are seen as inseparable concepts or happiness is regarded as a state free from distress (‘liking’ without ‘wanting’) ( Kringelbach and Berridge, 2010 ; Berridge and Kringelbach, 2011 ; Loonen and Ivanova, 2016 ; Lustig, 2017 ). Whether or not pleasure is included in the definition of happiness , to the best of our knowledge there is no study that includes craving (intense desire, longing) as a trait of happiness .

Thus, based on the mentioned definitions and on the association between craving and arousal ( Kennedy et al., 2015 ), craving for playing VG may subscribe itself within the realm of pleasure , but stands outside of the happiness’ sphere.

Within the frame of this research, Pleasure refers to the hedonic reward processes driven by a desire to obtain a gratification that can lead to craving in certain circumstances ( Berridge and Kringelbach, 2011 ). Pleasure has been associated with the dopaminergic circuit which can, in certain circumstances, function in an addictive mode and can affect also habits, conditioning, motivation and executives functions such as decision making, inhibitory control, etc. ( Volkow et al., 2011 ).

Happiness is understood as contentment and euthymic state, in line with a happy emotional state defined by a positive valence and low arousal ( Jatupaiboon et al., 2013 ). Physiologically, this state implies a reposed mind; akin to the relaxation state measured through the brain electrical activity ( Teplan and Krakovskà, 2009 ). In the literature this mood is related to the serotoninergic circuit ( Lustig, 2017 ).

To the best of our knowledge, there is no existing questionnaire focusing on the association between VG and pleasure/happiness. Thus, our study required a preliminary phase to design such self-report tool whose aim is to explore the perceived emotional states (pleasure/happiness) associated with VG play.

As far as we know, distinguishing the perception of these two emotional states in the frame of an addiction has not been yet the object of formal research, hence the reduced literature on this specific issue, in particular the experimental one.

Consequently this research may be seen as a preliminary study, which aims at examining the possible confusion between pleasure and happiness within the addiction sphere. VG addiction has been chosen to explore the possible occurrence of this perceptional distortion. Emotional reactions of VG addicts and VG non-addicts were gauged via self-report scales and physiological data (Heart rate and Relaxation state) acquired by a range of biosensors.

Resulting from the mentioned background, it is hypothesized that addict VG users:

Are likely to confuse the notions of pleasure with that of happiness when associating their emotional states to VG play.

The results of this study are expected to show that addict VG users associate happiness with VG activities while feeling craving for playing accompanied by an increased HR and a low relaxation level. Given the shortage of previous researches on the specific issue related to the confusion between pleasure and happiness in VG addiction, the outcome of this study is approached in an exploratory manner.

From a therapy standpoint, this project intends to explore alternatives to deal with this kind of scenarios. More specifically, at the cognitive level, the idea is finding means to develop patients’ insights into these emotional states and thus increasing their ability to handle them.

Materials and Methods

Preliminary phase: design of the “pleasure and/or happiness and vg” questionnaire, participants.

In total 105 VG players participated in this survey, out of which 61 filled all the questionnaires required for the design of the “Pleasure and/or Happiness and VG” questionnaire. The mean age of these 61 participants was 24.28 and the standard deviation 5.48. There were 33 males (54.1%) and 28 females (45.9%). The mean of playtime during working days was 4.49 h and the standard deviation 6.82, and during holidays and weekends 4.68 h and the standard deviation 3.13.

An online survey was run via video game forum and Reddit site (network of communities with common interests). The purpose of this survey was to evaluate the internal coherence of our self-report tool (Pleasure and/or Happiness and VG) relative to two validated questionnaires (on Hedonic tone and Happiness). Thus the survey consisted in filling the three questionnaires. Participants completed anonymously and voluntarily the questionnaires through their online gamers groups.

Two validated and known questionnaires were used to construct the ‘ Pleasure and/or Happiness and VG’ questionnaire through which the emotional states associated with VG activities were evaluated: the Snaith-Hamilton Pleasure Scale (SHAPS) ( Snaith et al., 1995 ), an assessment tool of hedonic tone, and the Oxford Happiness Questionnaire (OHQ) ( Hills and Argyle, 2002 ). The French version of these two questionnaires was used ( Loas et al., 1997 ; Bruchon-Schweitzer and Boujut, 2014 ).

The abbreviated SHAPS is composed of 14 items to assess the hedonic tone and the absence of it. The answer scale for each item offers four possible options ranging from ‘Definitely agree’ to ‘Strongly disagree.’ The OHQ is extensively used to evaluate the individual level of happiness. For each of its 29 items, the answer scale has 6 options going from ‘Strongly disagree’ to ‘Strongly agree.’

Several items of the SHAPS and the OHQ are quite adapted to the VG paradigm and lend themselves to be contextualized. For example, the first item of the SHAPS questionnaire is formulated as: “I would enjoy my favorite television or radio program.” In this case “television or radio program” is replaced by “video game.” An example of OHQ concerns the item “I am very happy,” which became “I am very happy when playing VG.” So, these kinds of items constitute the questionnaire whose aim is identifying the emotional states that users associate with VG. Initially, eight items were adapted to VG from these two questionnaires: four items from SHAPS and four items from OHQ. The answer scale provides with six possible options ranging from ‘fully disagree’ to ‘fully agree.’

Statistical Analysis

In order to ensure the usefulness of the designed self-report tool, an Alpha Cronbach test was run on the results of this survey to measure the internal coherence between the ‘VG and Pleasure/Happiness’ and the two other questionnaires (SHAPS and OHQ). Moreover, it has been examined whether there is a correlation between VG play frequency and the two areas explored in this survey: the general happiness level (OHQ) and the emotional states associated with VG (‘Pleasure and/or Happiness and VG’).

The Experiment

The study was announced through the Université Libre de Bruxelles (ULB) scientific social media as well as via leaflets available in public cyber games centers in Brussels. Gamers interested to participate in this study had to answer an on-line survey ( N = 163), in which the following data was gathered: age, play frequency, name of VG played and a validated test to assess the gaming addiction level (Gaming Addiction Scale, Lemmens et al., 2009 ). The French version of this scale was used ( Gaetan et al., 2014 ). Being used to play to at least one of these five popular VG (Fornite, Overwatch, League of Legends, Counter-Strike or Rocket League) and an age ranging from 18 to 70 years old were the inclusion criteria. Competing against another team and playing in groups are the common characteristics of these VG. The exclusion criteria were having vision impairments and neurological problems.

Two groups of gamers were invited to participate in this study: addict users (AU) and non-addict users (NAU). None of the invitees met the exclusion criteria. The selection and recruitment were based on the score obtained in the test on gaming addiction, resulting in: AU ( N = 12) and NAU ( N = 17) (7 females and 22 males, ranging from 19 to 29 years old). They were all French speakers Belgian residents. The mean age was 23 and the standard deviation of 3. The difference between sexes in terms of VG addiction is not statistically significant (3/7 AU females and 9/22 AU males, U 45.5, p = 0.130).

This experiment took place within the frame in the usability laboratory of the Research Centre of Work and Consumer Psychology, Université Libre de Bruxelles (ULB).

Before the experiment all the procedures were explained to participants and their consent was asked on formal basis. They were informed that:

– This experiment aims at better understanding the video game phenomenon (without mentioning the issue relative to the emotional states and VG).

– They have to fill several questionnaires (in French).

– Some non-invasive artifacts are set to gather measurements on physiological signals while they watch video clips.

– The Ethical Committee of ULB approved this study in accordance with the Declaration of Helsinki.

The participants were welcome into the testing room of the laboratory by the examiner. They were seated and given an informed consent form. Once the form was read and signed, the study procedure was explained. Then, the Electroencephalogram (EEG) headset was placed onto the participant’s head and an impedance check was run.

Before the beginning of the experiment, each participant chose his/her favorite VG he/she uses to play among the five initially proposed. During the experiment, the examiner observed the participant through a one-way-glass, avoiding interference.

Finally, participants were thanked for their participation, compensated and given information on obtaining the results of the study. The whole experimental run took around 1 h.

Prior to starting the operational phases of the experiment, all devices are set to initiate the baseline recording of all the physiological signals.

Six phases compose this experiment ( Figure 1 ). In each phase of the experiment the emotional states associated with VG were examined either through self-report questionnaires or via physiological measures. The physiological measures were recorded during the visioning of two sorts of video clips: VG clips whose aim was to induce craving and neutral video clips (documentaries on nature) intending to reduce craving.

Figure 1. Synthetic view of the experimental phases.

The six experimental phases:

(1) “Pleasure and/or Happiness and VG” (six items): Participants were invited to fill the self-report questionnaire designed in the preliminary phase.

(2) Watching a neutral clip during 2 min while recording physiological signals related the mentioned two emotional states. This phase intends to decrease craving in participants.

(3) Craving score: Participants were asked to express their craving state to play their favorite VG via a one item self-report questionnaire.

(4) Watching a VG clip during 2 min while recording the same physiological signals as in phase two related to the mentioned emotional states. The objective of this phase is to increase craving in participants.

(5) Craving score: the same procedure and self-report tool as in phase 3 were applied.

(6) Submission of three self-report questionnaires:

(6.1) “Pleasure and/or Happiness and VG” (Three bipolar items).

(6.2) “Key words and VG”: participants were invited to associate a list of words to VG activities.

(6.3) “Pleasure and VG or Happiness and VG” (one bipolar item): participants were asked to associate one of the two emotional states to VG play.

The cycle from the 2nd phase to the 5th phase was repeated five times for each participant. In each of these five cycles, different episodes of video clips (the chosen VG and the neutral clip) were shown randomly so as to avoid the habituation phenomenon and minimize the influence that the order of the sequence of episodes could have on participants’ responses.

– Experimental groups: AU and NAU

The Gaming Addiction Scale (GAS) ( Lemmens et al., 2009 ; Gaetan et al., 2014 ) was used to constitute these groups. As a tool to measure game addiction, GAS possesses significant assets. Lemmens et al. (2009) showed the validity of this scale from a cross population point of view and its one-dimensional characteristic resulting from the factorial analysis. In addition, in the same study it has been shown the concurrent validity of GAS insofar as this scale is associated with play frequency as well as with psychological features related with game addiction, namely decreased level of social competence and of well being, and high level of aggression and of loneliness. Moreover, high scores in GAS are also linked with attentional deficiencies in response inhibition when perceiving game cues ( van Holst et al., 2012 ; in Khazaal et al., 2016 ), which converges with results produced by other researches associating impulsivity and cue reactivity with other addictive behaviors ( Billieux et al., 2011 ; Khazaal et al., 2012 ; Torres et al., 2013 ). Relative to other game addiction measurements, GAS has the most complete covering of the Internet gaming disorder criteria of the DSM-5 ( Petry et al., 2014 ). Although it was initially designed for adolescents, there are substantial evidences to state that GAS is applicable for young adults too ( Khazaal et al., 2016 ).

Each of the seven items of this scale starts with the question “How often in the last 6 months…?” to explore the impact of video gaming on different aspects of the subject’s life. The possible answers are: never, rarely, sometimes, often and very often. The first two answers score 0, the last three answers score 1. If the total sum of these scores is 4 or higher, the subject is considered an AU according to this scale.

– The experiment

In the first phase, participants were asked to fill the “ Pleasure and/or Happiness and VG” questionnaire composed by six items: three items that tie Pleasure (P) and VG, three items that tie Happiness (H) and VG (six-items in total).

The answer scale for each item was composed of six options ranging from ‘Fully disagree’ to ‘fully agree.’ Each of these six items is answered separately, thus the overall possible results of this questionnaire can be: (1) P and VG > H and VG or (2) H and VG < P and VG or, (3) P and VG = H and VG.

In the second phase (Neutral video clip), two physiological signals related to Pleasure and Happiness were recorded. Based on the correlates found between HR and craving, this physiological signal is used as an indicator of arousal ( Kennedy et al., 2015 ).

Despite the difficulty in defining and in measuring happiness , the brain electrical activity is recorded (Electroencephalogram, EEG) mainly to detect the relaxation state. This state appears close to the notion of happiness; in the literature it is accepted that the increase of alpha waves is correlated with mental and physical rest ( Teplan and Krakovskà, 2009 ).

In the third phase, participants were asked to express their craving state to play his/her favorite VG. The statement employed in this self-report tool was: “State your present craving for gaming.” Participants have to choose the answer that best fitted their self-assessment among six possible answers offered by the scale ranging from “I do not feel any craving for gaming” to “I feel a very strong craving for gaming.”

In the fourth phase (VG clip), the same physiological signals as in the second phase were measured.

In the fifth phase, the same procedure to assess craving for gaming as in the third phase was employed.

In the sixth phase, three other self-report questionnaires were submitted to participants and used to evaluate the association between the mentioned emotional states and VG:

– “Pleasure and/or Happiness and VG” (three bipolar items). The same six items of the “Pleasure and/or Happiness and VG” questionnaire used in phase 1 were presented in a bipolar structure: three items opposing “Pleasure and VG” vs. “Happiness and VG.” For example, if in the six items questionnaire the items “I would enjoy my favorite VG” (Pleasure/VG) and “I am happy when playing VG” (Happiness/VG) are presented separately, in this questionnaire they are part of the same item: “I would enjoy my favorite VG” vs. “I am happy when playing VG.” By doing so, participants are encouraged to choose which of their emotional states (Pleasure, Happiness) is associated with VG playing. That said, the scale has an uneven number of options (five) between the two extremes, the central option representing the equal association of Pleasure and Happiness with VG play. Thus, the overall possible results are identical as in phase 1.

– “Key words and VG”. Participants were asked to choose three words (out of ten) that they associate most with their VG activities. These 10 key words come from the semantic mapping elaborated in this research of the terms used in the formal statements defining pleasure and happiness in this study. For example, some words from the happiness sphere are contentment and well being , whereas desire and joy relate to pleasure . Besides, they are in line with both definitions Lustig’s (2017) . Only the ten words (French version) were shown to participants. Although the possible results are similar to those of six-item “Pleasure and/or Happiness and VG” questionnaire and three-bipolar item “Pleasure and/or Happiness and VG” questionnaire, this time the same association (emotional states and VG) is tackled via key words directly linked to the two studied emotional states ( Pleasure, Happiness ) but without mentioning them. This self-report format intends to gain accuracy in the identification of gamers’ emotional states associated with VG.

– “Pleasure and VG or Happiness and VG”. The written definitions of both pleasure and happiness , based on work Lustig’s (2017) , were shown to participants. Then they were asked to read carefully these definitions and to take them into account when answering one bi-polar item that opposes “Pleasure and VG” vs. “Happiness and VG.” Unlike in the three-bipolar items questionnaire, the answer scale between these this bipolar item has an even number of options (six). This time is an “either/or” choice they are faced with, therefore the possible results are: P and VG < H and VG or P and VG > H and VG. Basically this questionnaire intends to strengthen consistency in participants’ insights into this issue by inviting them to confront their perception of their emotional states associated with VG play with the mentioned formal definitions, comparable to an emotions reappraisal process ( Seay and Kraut, 2007 ).

In short, four self-report questionnaires (see Annex ) aim at exploring this dependent variable (association between these two emotional states and VG play) by looking at the consistency of participants’ answers to the different formats of questions. The questions’ formats are:

– Pleasure and/or happiness can be associated with VG (six independent items);

– Pleasure and/or happiness can be associated to VG (three bipolar items);

– Pleasure and/or happiness can be associated to VG through key words defining the two emotional states (without mentioning the words pleasure and happiness );

– Pleasure or happiness can be associated to VG (written explicit definitions of pleasure and happiness are given to participants).

This approach aims at exploring the coherence between the self-reported answers and the physiological signals, as a means to objectivize the perceived emotional states associated with VG play by the two mentioned groups of participants (addict gamers and non-addict gamers).

The previously mentioned theoretical framework indicates that the notion of craving relates to an arousal state that could lead to an addictive pattern and consequently stands out of the realm of happiness.

Expected Results

Based on the analysis made on this issue previously as well as on the hypothesis of this study, the expected results could be synthesized as shown in Table 1 .

Table 1. Summary of the expected results.

– Self-Report Questionnaires

For the self-report questionnaires, it is expected that, compared to NAU, the AU group:

– In “Pleasure and/or happiness associated with VG” (six independent items) associates more happiness than pleasure with VG play.

– Reports more craving for playing after watching VG clip.

– In “ Pleasure and/or happiness associated to VG” (three bipolar items) associates more happiness than pleasure with VG play.

– Associates VG play with key words more related to happiness category than to those of pleasure .

– In “ Pleasure or happiness associated to VG” associates VG play with pleasure (like NAU).

– Physiological Signals

It is expected to observe an interaction between the groups (AU, NAU) and the conditions (VG clip, Neutral clip). Namely, it is assumed that visioning the VG clips has an effect on AU increasing HR while decreasing Relaxation.

After verifying the normality of distributions (Kolmogorov–Smirnov), the means comparison between the two groups (NAU, AU) was calculated for self-report questionnaires measuring the association between VG and Pleasure/Happiness (Mann–Whitney U ) for the six-items “Pleasure and/or Happiness and VG,” the three-bipolar items “Pleasure and/or Happiness and VG” and the one-bipolar item “Pleasure and VG or Happiness and VG.” The Chi square was used for “Key words and VG.” In order to determine whether there are differences between independent groups over time and to identify possible interactions between the two independent variables on the dependent variables, a two-way mixed ANOVA (within and between subjects) was used for the craving scores and the physiological signals recorded ( Table 2 ).

Table 2. Synthetic view of independent and dependent variables.

The experiment was run on a desktop computer with an Intel Core i7 quad processor and 8 GB RAM, running Windows 10. Stimuli were displayed on a 22-inch monitor and resolution was set to 1680 × 1050. Participants used standard mouse and keyboard as input devices. EEG measurement includes detecting the fluctuation of voltage potential generated by large group of neurons in the brain. The EEG signal was obtained through the use of EPOC headset. This device allows to remotely getting data of brain activity using a wireless set of fourteen electrodes (AF3, AF4, F3, F4, F7, F8, FC5, FC6, T7, T8, P7, P8, O1, O2) sampled at 128 hertz.

The relaxation state was measured by one of the composite metrics of the Emotiv software. HR was measured by using Schimer 3 (Photoplethysmography). The I. Motions software version 7.1 (Imotions Inc. 2018) was used to recording the mentioned data and presenting stimuli to participants. The statistical analysis was conducted with IBM SPSS statistics v.25.

Design of the “Pleasure and/or Happiness and VG” Questionnaire

The Cronbach’s alpha (0.859) showed a high internal coherence between the SHAPS and three items (out of four) of the “Pleasure and VG” within the “Pleasure and/or Happiness and VG” questionnaire. The fourth item has been disregarded; its presence would have dropped the Cronbach’s alpha to 0.685. The internal coherence obtained between the OHQ and the “Happiness and VG” items within the “Pleasure and/or Happiness and VG” questionnaire was quite high for the four items concerned (alpha 0.901). However, the internal coherence between these four items was too weak due to one item (alpha 0.407). The exclusion of this item raised the alpha significantly (0.836). Consequently, only the consistent items have been kept (six out of the initial eight items: three on “Pleasure and VG,” and three on “Happiness and VG,” see Annex ).

Moreover, it has been examined whether there is an association between VG play frequency and the two areas explored in this survey: the general happiness level (OHQ) and the emotional states associated with VG via the “Pleasure and/or Happiness and VG” questionnaire. The constitution of the group of frequent gamers and that of non-frequent gamers was determined by calculated median (18 h per week). In line with several studies linking problematic gaming and well-being and life satisfaction, a moderate negative correlation ( R = −0.249; p = 0.056) was found between VG high play frequency and the OHQ scores ( Griffiths, 2008 ; Lemmens et al., 2011 ). In addition, there is a marginal significant difference [ T (58) = 1.923; p = 0.059] between frequent VG users and non-frequent VG users relative to the OHQ scores.

The “Pleasure and/or Happiness and VG” Six-Items Questionnaire

The Kolmogorov–Smirnov outcome indicates the need for using a non-parametric test to compare the two groups. The Mann–Whitney test shows that there was no significant difference observed between the AU and NAU relative to association between VG play and pleasure (item 1. U = 78, p = 0.30; item 3. U = 75, p = 0.24 and item 5 U = 86, p = 0.49) ( Table 3 ).

Table 3. Descriptive statistics of “Pleasure and/or Happiness associated with VG” (6-items): [Pleasure (P), Happiness (H) associated with VG].

In contrast, there is a significant statistical difference in the three items where AU associate VG play with happiness (item 2. U = 40, p = 0.005; item 4. U = 54, p = 0.034 and item 6. U = 34, p = 0.002) more than NAU.

Craving Scores

Results in craving ( Table 4 and Figure 2 ) show a statistically significant interaction F (1,25) = 4.78 ( p = 0.038). Indeed, relative to the neutral clip, the VG clip condition has significantly amplified the reported craving difference between the two groups (AU craving score > NAU craving scores).

Table 4. Descriptive statistics for self-report Craving.

Figure 2. Self-report craving (groups: AU, NAU; conditions: Neutral clips, VG clips).

Physiological Signals Measurements

The AU’s relaxation is significantly lower [ F (1,24) = 8.616; p = 0.007] than NAU’s in both conditions (Between-Subjects Effects). The relaxation level decreases in both groups during the VG clip. On the other hand, conditions do not influence the relaxation difference between the two groups [ F (1,24) = 0.001; p = 0.98] ( Table 5 and Figure 3 ). Furthermore, there is a significant statistical gender difference in both conditions (Neutral clip: Male 17.36, Female 7.57. U = 25, p = 0.008 – VG clip: Male 17.09, Female 8.43. U = 31, p = 0.019).

Table 5. Descriptive statistics: Relaxation index (EEG EPOC, Emotiv software).

Figure 3. Relaxation [groups: AU, NAU; Conditions: (1) Neutral clips, (2) VG clips].

Concerning the other physiological variable (HR) ( Table 6 and Figure 4 ), there is an effect of VG clips on both groups [ F (1,15) = 20.802; p < 0.001]. Nevertheless, there was no statistically significant interaction [ F (1,15) = 0.028; p = 0.86], nor an effect of addiction on VG clip condition [ F (1,15) = 0.083; p = 0.777]. It is important noting that due to corrupted data the number of valid subjects taken into account was 17 (8 AU and 9 NAU).

Table 6. Descriptive statistics: Heart Rate (HR).

Figure 4. Heart Rate [groups: AU, NAU; Conditions: Neutral clips (1), VG clips (2)].

The “Pleasure and/or Happiness and VG” Three-Bipolar Items Questionnaire

The descriptive statistics of this three-bipolar items questionnaire ( Table 7 ), indicate that the AU group linked VG activities more with happiness than the NAU group. The Mann–Whitney test shows a significant difference between these two associations ( U = 47; p = 0.013).

Table 7. Descriptive Statistics: Pleasure/VG vs. Happiness/VG (3 bipolar items).

Key Words and VG

Results state the absence of significant difference between AU and NAU in associating the key words from the Pleasure cluster with VG play, and words from the Happiness cluster with VG (Chi square, p = 0.942) ( Table 8 ). When taking words separately, the biggest gap between the two groups relates to the word well-being (belonging to the happiness cluster) associated to VG play (AU: 25%, NAU: 0%).

Table 8. Descriptive statistics: number of words per category (Pleasure, Happiness) associated to VG play chosen by NAU and AU.

“Pleasure and VG or Happiness and VG” (One Bipolar Item Questionnaire With Written Definitions)

The outcome of this questionnaire indicates that there is no significant difference between AU and NAU ( U = 102, p = 1). Both groups have clearly associated VG play with pleasure ( Table 9 ).

Table 9. Descriptive statistics: Happiness/VG or Pleasure/VG (1 bipolar item, with Definitions of Pleasure and Happiness shown to subjects).

The following scheme summarizes the outcomes of the self-report tools used to evaluate the association between the emotional states (Pleasure and Happiness) with VG play ( Table 10 ).

Table 10. Synthetic view of self-report results (Emotional states associated with VG play).

The following table indicates the mean, standard deviation and Skewness and Kurtosis values of the self-report craving, the HR and the relaxation level for both groups in the two conditions ( Table 11 ).

Table 11. Descriptive statistics for self-report Craving, Relaxation, Heart Rate.

Overall, the results of this study show that AU associate happiness to VG while reporting craving for VG play and having a low relaxation level. These outcomes observed in this experiment constitute a bundle of arguments that argue in favor of the hypothesis of this study ( Lustig, 2017 ). Indeed, in AU, the high self-report craving score and low Relaxation level during VG clips visioning do contrast with their association of VG more with happiness than with pleasure in the mentioned “Pleasure and/or Happiness and VG” questionnaires (six-items and three-bipolar-items) relative to NAU. Consistent with previous findings in this area, these four measurements highlight the coexistence of the perception of happiness linked with VG play combined with elements related to pleasure such as craving ( strong desire, wanting ) ( Pollard, 2003 ; Griffiths, 2008 ; Waterman et al., 2008 ). Since craving and low Relaxation are rather incompatible with the mentioned notion of happiness ( Pollard, 2003 ; Waterman et al., 2008 ; Lustig, 2017 ), these indices may raise the question as to how accurate are AU’s insights into their emotional states associated to VG play and may support the idea that AU’s perception of their emotional states is somewhat distorted. In the literature, VG addiction would be linked with impairment in the self-regulation process, this finding may be linked with the difficulties AU have to observe and evaluate their own behavior ( Seay and Kraut, 2007 ). Besides, the mentioned results suggest that VG clip effect on self-report craving would depend on the addiction level.

Considering that sensing happiness and craving are probably experienced as positive emotions by AU, and that usually negative and positive emotional events are reported to last longer and shorter respectively ( Gil and Droit-Volet, 2012 ; Tian et al., 2018 ), the arousal triggered by motivating stimuli, may modify the time perception and could mediate the effect of emotions on behavior ( Gil and Droit-Volet, 2012 ). In other words, the level of excitement produced by VG play could make AU underestimate the time spent at this activity, which may be perceived as an alleviating evasion free from stressors and possibly assimilated with the notion of happiness . This hypothetic mechanism would match one of the possible motives for online gaming ( Demetrovics et al., 2011 ). In this sort of precognitive process, several studies mentioned the involvement of the amygdala in interaction with the thalamus together with the dopaminergic system and a poor inhibitory control ( Gil and Droit-Volet, 2012 ; Petry et al., 2015 ).

It is noteworthy underlining that the bipolar structure of the three-items questionnaire increases the relevance of this outcome. In effect, although participants were incited to choose between the two emotional states opposing each other (VG and pleasure vs. VG and happiness), like in the six-items questionnaire, AU again did choose happiness as the main emotional state linked with VG play. This outcome would further state the difference between these two groups when it comes to associating the two emotional states to VG play. Besides, this would reveal to an important extent that the possibility whereby pleasure and happiness were regarded as synonyms could be overcome. In other words, this outcome shows that the similarity of meanings of these two concepts did not prevent these groups to make a clear choice. Finally, the similar scores obtained in the two questionnaires (six-items and three-bipolar items “Pleasure and/or Happiness and VG”), in spite of the different disposition of the same items in these two instances, strengthen the value of the designed scale (“Pleasure and/or Happiness and VG play”).

The absence of interaction between the two independent variables on HR may be explained by the fact that a higher arousal would take place in AU when playing VG rather than when watching at VG clips. Moreover, the reduced number of valid subjects when measuring this physiological parameter (due to technical recording problems) could have contributed to this outcome too. The fact that the independent variables did not produce the expected different HR effects on AU and NAU could also be linked with one of the limitations of this study: the difficulty in integrating in this research the interaction between HR and depression (as mentioned, VG addiction is positively correlated with depression) ( Griffiths et al., 2012 ) that may lead to HR index modifications ( Cipresso et al., 2014 ). In sum, this issue illustrates that the difficulty to circumscribe the notion of happiness is also reflected in the complexity to establish physiological correlates so as to objectify this emotional state ( Cipresso et al., 2014 ).

Associating the clusters of key words with VG did not produce the expected results. Since AU linked VG with both pleasure and happiness , may be these words played a clarification role and facilitated Au’s insights into their emotional states when playing VG. It could also suggest the inadequacy of this self-report tool. However, it is probably worthwhile mentioning an index related our hypothesis: when taking words separately, the word “well-being” associated with VG play was chosen by 25% of AU and by 0% of NAU.

The outcome of the binary question in the “Pleasure and VG or Happiness and VG” one-item questionnaire with the definitions of pleasure and happiness ( Pollard, 2003 ; Deci and Ryan, 2008 ; Waterman et al., 2008 ; Kashdan et al., 2008 ; Lustig, 2017 ) shows that AU ceased associating happiness to VG play and instead, like NAU, clearly linked pleasure to their cyber activity. Caution is required in the analysis of these results because the validity of this questionnaire remains to be demonstrated. Having instructed participants to answer the bipolar question by taking into account the written definitions of the two measured emotional states, did modify the result of AU group relative to both questionnaires (“Pleasure and/or Happiness and VG” six-items and three bipolar items). Within the framework of this careful approach, it could be hypothesized that explicit definitions of the two emotional states induced AU to adopting an introspection mode through a more pronounced involvement of cortical brain structures, akin to a therapeutic process in which the appropriate verbalization of pleasure and happiness facilitates the clarification of one own feeling as a prerequisite to elaborate more adaptive behavior in spite of the constraining psychological characteristics usually associated with VG addicts ( Kim et al., 2007 ; Kashdan et al., 2008 ; Wenzel et al., 2009 ).

This may be regarded as an example of emotions reappraisal which would increase accuracy of insights into one-self, reduce distorted perception of emotions and assess the adequacy of the behavioral response to a given stimulus ( Compare et al., 2014 ). In other words, it could be posited that the mentioned explicit definitions have somewhat constrained AU to use a cognitive approach to examine their emotional states related to VG play rather than merely relying on the sensory information as it tends to occur when sensing craving for video gaming ( Wang et al., 2017 ).

Moreover, the result of this one-item binary questionnaire would further support the hypothesis. In effect, the studied interrelation between hedonia and eudaimonia suggests that a highly rated hedonic activity (VG play in this case) is usually related with low rating in eudaimonia ( Waterman et al., 2008 ). This interpretation would fit with the resounding association between depression and gaming disorders ( Lemmens et al., 2011 ; Hull et al., 2013 ; Sarda et al., 2016 ; Bonnaire and Baptista, 2019 ) together with the confusion between pleasure and happiness occurring in addictive activities (AU associated VG with happiness in the first two self-report questionnaires and ended linking pleasure with VG in the last one-item questionnaire) ( Pollard, 2003 ; Lustig, 2017 ).

Overall, the more explicit the definition of pleasure and happiness and the narrower the choice offered by the self-report questionnaires, the less confusion of emotional states associated with VG occurred in AU group members whereas NAU invariably associated pleasure to VG as illustrated in Figure 5 .

Figure 5. Shift of AU perception of their emotional states associated with VG according to the self-report tools.

Based on these results, it could be postulated that the tendency of AU to perceive happiness when feeling craving and pleasure linked to VG play, might be moderated by a clarifying cognitive process on the meaning of these studied emotional sates, which would interfere with the behavioral habits linked to the urge of gaming ( Ko et al., 2009 ).

The findings resulting from “Pleasure and/or Happiness and VG” six-items questionnaire could be regarded as an illustration of the confusion that AU might have when linking the studied emotional states with VG play. Unlike NAU, the significantly higher association between VG play and happiness expressed by AU matches the perceived level of well being reported by individuals with Internet gaming disorders ( Griffiths, 2008 ). On the other hand, apart from well-being , the same author cites euphoria as the other main emotional state that addict gamers may report when playing VG. Whilst happiness and well-being rely on each other to define themselves, euphoria would convey the notion of intense excitement, which would rather stand in the pleasure sphere. Moreover, in medical terms, euphoria refers to a feeling of great elation, not necessarily founded (especially when resulting from substances consumption). Since AU also associated VG with pleasure although they did it to a lesser extent than with happiness, it could hypothesized that the feeling of intense excitement derives, at least partially, from satisfying the craving for VG play, which in turn could engender relieve experienced as a sense of well-being ( Loonen and Ivanova, 2016 ).

The impact of VG clips on AU craving and relaxation scores underlines relevant aspects of this study, which support the hypothesis of this research. First of all, it highlights the incongruent perception of AU’s emotional states whereby both craving and happiness coexist as emotional states associated with VG play. Thus, this finding constitutes a relevant component of the confusion that consists in placing a short-term pleasure (VG play) within the sphere of happiness. Besides, the low relaxation state of AU would correspond with their self-reported craving and, therefore, further highlights the contrast between the perceived happiness associated with VG play and the indicators measured during the VG clip visioning (high craving level and low relaxation state level). Finally, it is noteworthy mentioning that relaxation was the only measure in this study where gender differences were observed. The lower relaxation level in female gamers in both conditions might be related to the gender expectation about playing VG in society at large and in the gamers’ community in particular ( Shen et al., 2016 ). Indeed, since female gamers are a minority in these sorts of VG ( Shen et al., 2016 ) (in line with our sample: 7 females, 22 males), it could be posited that they feel under scrutiny in an activity regarded as male oriented.

Putative Reasons of Distorted Perceptions of Emotional States Associated With VG Addiction

The social dimension of popular VG has been identified as one of the factors that may explain the addiction pattern ( Hull et al., 2013 ). In this kind of competitive games, improving the required abilities and obtaining better results would be part of the key motives for VG play ( Demetrovics et al., 2011 ), that usually generates the appreciation and the acceptance of the other group players. Getting this sort of feedback from others can be motivating indeed, especially when taking into account the correlation between IGD and social isolation, low self-esteem, traumatic experiences, depression and low life satisfaction ( Petry et al., 2015 ; Schimmenti et al., 2017 ; Bonnaire and Baptista, 2019 ). In turn, these psychosocial characteristics are probably related also with the high impulsivity level in VG addicts ( Billieux et al., 2011 ), which has been found to be associated with difficulties in interpersonal relationships ( Ryu et al., 2018 ). Thus, it would seem that VG activities are, at least partially, sating the mentioned social and psychological deficiencies. This suggests that AU’s emotional states related to VG play may be quite contrasting, in which components of happiness (i.e., interacting with others, fellowship and belonging to a group) are intertwined with those of short-term pleasure (i.e., craving for getting quick results, praise from others, etc.) ( Loonen and Ivanova, 2016 ). Now, craving for undertaking these cyber activities to respond to the mentioned social isolation issues places this emotional state much closer to the ‘pleasure governed by desire’ than to ‘atmosphere of good fellowship’ (Happiness) ( Lawrence et al., 2014 ; Lustig, 2017 ).

The flow, defined as the emotional state embracing perception distortion and enjoyment produced by VG activities, is another element that can create confusion in gamers’ insights into their emotional states ( Chou and Ting, 2003 ; Hull et al., 2013 ). As described in the mentioned study, experiencing flow implies not only losing the notion of time but also merging oneself with the VG actions. In these conditions, the gamer’s senses and attention are in the here and now , with little or no awareness about sources of stress relative to past, present or future events. In this line, the motivation to experience immersion has been associated with problematic gaming ( Billieux et al., 2011 ). Considering the fact that loneliness and depression have been identified as predictors of VG addiction and of Internet Gaming Disorders ( Hull et al., 2013 ; Sarda et al., 2016 ), it is understandable why in gamers’ mind experiencing flow could equate this feeling with a relieving emotional state ( Loonen and Ivanova, 2016 ). This sense of alleviation could match the notion of happiness as free from distress ( Kringelbach and Berridge, 2010 ; Loonen and Ivanova, 2016 ) if it resulted from the quality of real life being lived. Instead, in AU, this relieving and enjoyable emotional state would be engendered by a virtual activity (VG), possibly used as a means to escape from stress and to forget tensions ( Demetrovics et al., 2011 ; Bonnaire and Baptista, 2019 ). In the literature, the escaping strategy is a way to find relieve from stressors through the engagement in a pleasant activity, which may end up representing a space of happiness ( Seay and Kraut, 2007 ).

In sum, the incongruence lies in the coexistence of regarding VG as a space of happiness while using VG to get quick pleasures and relief. Individuals suffering from this disorder tend to pursuit short-term pleasures rather than long-term gains ( Dong and Potenza, 2015 ). Being driven by short-term gratifications rather belongs to the reward-seeking realm ( Waterman et al., 2008 ; Lustig, 2017 ). Thus, this pleasant emotional state could be associated with the arousal linked to a reward seeking behavior through which quick and positive results are obtained, which in turn reinforce the mentioned behavior. Probably, this intense arousal situates itself within the sphere of pleasure as a dysfunction in the rewarding system ( Pollard, 2003 ; Berridge and Kringelbach, 2013 ; Lustig, 2017 ) and not in that of happiness in spite of the relieving benefits it provides.

Another possible reading on why the emotional states generated by these cyber activities are linked with happiness may be related to the way in interpreting the experienced sensations. This representation is probably shaped by the individual background, experiences, culture, etc. From a brain mechanism stand point, conscious liking does not limit it self to a sensory outcome, it is also translated into a subjective liking through the recruitment of cognitive processes ( Berridge and Kringelbach, 2013 ). Indeed, these authors state that conscious pleasure rating is sometimes detached from affective reactions as people can elaborate reasons to themselves for how they should feel. Therefore, associating VG with happiness may be the result of a rationalization process to reduce the cognitive dissonance. In other words, the unwished consequences of the VG addiction pattern (increased stress, problems at working, studying, socializing, etc.) ( Griffiths et al., 2012 ) probably produce an increasing amount of pressure (due to the difficulty to reduce gaming time, guilt, etc.) that can become overwhelming if it lasts too long. Consequently, if the affected individuals are unable to master the yearning for VG, perceiving VG activities as a source of well being may reduce the mentioned pressures insofar as the notion of happiness usually suggests a socially acceptable mood, a legitimate aim and a safe emotional state. In this perspective, equating happiness with satisfying craving and with short-term pleasure might contribute to feed the addictive pattern ( Lustig, 2017 ).

In a broader perspective, the rationalization process described in the previous paragraph may be also related with coping strategies to deal with adversity. For instance, it has been observed that problematic gamers may use VG play as a means to cope with stressors and to enhance mood ( Demetrovics et al., 2011 ). An association has been found between stressful life events and addiction to Internet activities ( Schimmenti et al., 2017 ), with the mediating role of psychological needs satisfaction and the moderating role of coping styles ( Dongping et al., 2016 ). Several theories and studies support this approach that strives for a more holistic understanding of this issue. The self-determination theory postulates that humans share three universal psychological needs ( Deci and Ryan, 2000 ; in Dongping et al., 2016 ): autonomy (i.e., feeling of being self-determining in one’s behavior), relatedness (i.e., the feeling of connectedness to others) and competence (i.e., the feeling of dealing with issues in a competent manner). Besides, individuals can adopt different strategies to cope with adversity ( Lazarus and Folkman, 1984 ; in Dongping et al., 2016 ). According to Zheng et al. (2012 ; in Dongping et al., 2016 ), the positive coping approach is the set of strategies aiming at problem solving, support seeking and cognitive restructuring to address the stressors. On the other hand, according to the same authors, the negative coping consists in strategies such as blaming, social withdrawing, denial and disengagement so as to avoid the stressful situations. Now, a parallel can be established between these two coping styles and the brain activities involved in the goal-directed learning and the habit learning.

The goal-directed learning would correspond to the positive coping style insofar as it focuses on the relationship between an action and the motivational value of the outcome, and is associated with the activation of the prefrontal cortex, the dorsomedial striatum and the dorsomedial thalamus ( Ballaine and Dickinson, 1998 ; in Schwabe et al., 2012 ). On the other hand, habit learning, would be linked with the avoidant coping style. This learning process encodes the relationship between a response and preceding stimuli without taking into account the outcome caused by the response and is related to the activation of the dorsolateral striatum ( Yin et al., 2004 ; Tricomi et al., 2009 ; in Schwabe et al., 2012 ). According to Schwabe et al. (2012) , stressful situations may modulate the processes involved in instrumental learning in a way that may produce the shift from goal-directed learning to habitual learning.

In line with these findings, it has been observed that, like cocaine cues, psychological stress induction can generate the same craving response in a cocaine abusers population ( Bradley et al., 1989 ; Wallace, 1989 ; in Sinha et al., 2000 ). The relevance of these observations lies in the fact that both SUD and behavioral addictions (including gaming disorders, Han et al., 2011 ) recruit to an important extent common brain regions and produce similar physiological patterns, as quoted in the introduction of this document.

Considering the association between unhappiness and VG disorders mentioned earlier, it could be posited that the gamers concerned could not overcome the causes of their unhappiness. Indeed, studies suggest that subjects with Internet gaming disorders embark in VG play more to deal with negative affect than to achieve a good performance in the game ( Schimmenti and Caretti, 2010 ; Billieux et al., 2013 ; both in Bonnaire and Baptista, 2019 ). In this scenario, based on the mentioned studies, a low level of happiness would imply that psychological needs are somewhat unmet and associated with the avoidant coping style together with the habit learning. Furthermore, this pattern is supported by compensatory Internet use theory, which postulates that adversity can operate as a stimulus to seek psychological comfort (i.e., satisfying the psychological needs via the cyberspace) ( Kardefelt-Winther, 2014 ; in Dongping et al., 2016 ).

In other words, the psychological comfort engendered by the VG activities in this population of gamers, combined with the characteristics of the avoidant coping style (denial, social withdrawal, avoiding stressful situation, etc.) and with the traits of the habitual learning (actions’ outcomes are disregarded, with little or no awareness of actions’ consequences), might explain, at least partially, the biased perception of the emotional states in AU ( happiness associated to VG) and of their causes of craving for VG. This assumption suggests that online gaming might not be the cause of VG addiction, but rather that VG excessive use could be a compensatory strategy to deal with pre-existing psychological characteristics and deleterious social context ( Kowert et al., 2015 ). For instance, some studies suggest that traumatic experiences, poor emotions regulation, elements of impulsivity and the motivation to experience immersion in a virtual world would increase the likelihood of IGD and Internet addiction ( Billieux et al., 2011 ; Schimmenti et al., 2017 ).

In sum, it would seem as if for AU the mentioned behavioral pattern is a manner to mitigate the difficulties to deal with stressors. This interpretation would be in line with the motives for play in problematic gaming ( Demetrovics et al., 2011 ). Through a massive survey these authors observed seven dimensions that would cover the entire spectrum of motives for VG play in all sort of on line games: escape (from reality), cope (with stressors, playing as a way to improve mood), fantasy (trying new identities/things in a virtual world), skills development (improving concentration, coordination, new skills) recreation (relaxing aspects of gaming), competing (sense of achievement), and social (knowing/being/playing with others). This study suggests that there would be positive and beneficial motives for playing (entertaining gaming) as well as harmful ones (problematic gaming). The correlations between these factors appear to shed light on the positive and negative aspects of gaming. Whilst the weakest correlation is between escape and recreation (also low correlation was found between escape and both, skills development and competition), the strongest correlations were observed between escape and cope and fantasy. These results would indicate that escape and coping are motives associated with problematic gaming, however, the authors argue that escapism would facilitate the coping efforts to deal with stressors and negative moods. Moreover, it is noteworthy underlining that escapism had the lowest mean score in this study among the seven dimensions, which would match with the prevalence level of problematic gaming mentioned previously ( Griffiths et al., 2012 ).

Probably, regarding AU, the accuracy in perceiving emotional states, the ability to deal with stressors and the quality of insights into oneself are dimensions that deserve much attention in the therapeutic processes.

Therapeutic Implications

A cognitive-behavioral approach may contribute to the recovery process by enabling problematic gamers to explore the motives that lead them to abuse of VG play ( Orzack et al., 2006 ; in Griffiths, 2008 ). Developing strategies to tackle stressors appears to be a therapeutic priority for treating this disorder. Consequently, this axis of work includes the understanding of the environmental demands that are perceived as exceeding the individual abilities to handle them. In this line, ensuring the accuracy of the individual’s insights into the emotional states linked to the sources of stress as well as to the game habit could increase the awareness of the underlying issues to be addressed. In particular, deciphering the conditioned desires (unconscious wanting) and the hedonic dimension (unconscious liking) ( Kringelbach and Berridge, 2009 ; Berridge and Kringelbach, 2013 ) linked to VG play may produce added value information for understanding and overcoming the problematic gaming pattern. Within this frame, it could be hypothesized that distinguishing between happiness and feeling alleviated could be beneficial to the therapeutic process, although it remains to be demonstrated.

Overall, this sort of therapeutic approach may contribute to reduce the alexithymia, usually associated with this kind of disorders ( Kandri et al., 2014 ).

In problematic internet/gaming several studies have explored and highlighted to role of alexithymia and its links with other therapeutic issues. For instance, it has been shown that alexithymic individuals are more associated with Internet addiction than non-alexthymic ones ( Baysan-Arslan et al., 2016 ). In this research, the authors consider that the difficulty in identifying and differentiating emotions that characterizes alexithymia may lead individuals with this affliction to regulate their emotional states via their addictive activities.

Another study showed that IGD would be related with alexithymia, anxiety and depression ( Bonnaire and Baptista, 2019 ).

Schimmenti et al. (2017) observed that traumatic experiences (mainly in males) and traits of alexithymia (mainly in females) were associated with Internet addiction symptoms, which may enable a tailored prevention and treatment approach. Besides, Internet addiction (including online role-playing) would be correlated with alexithymia, dissociation (protecting one-self in a more pleasant created reality as a means to deal with traumatic experiences) and insecure attachment ( Craparo, 2011 ).

However, the causal link in the association between alexithymia and Internet addiction would still need to be verified, as indicated by Mahapatra and Sharma (2018) . Moreover, discerning the nature of alexithymia remains an uneasy task: this emotional identification and differentiation disorder might be regarded as a stable personality trait that could increase risks of mental disorder development, and also may be seen as a defense mechanism to cope with psychological stressors ( Mikolajczak and Luminet, 2006 ; in Mahapatra and Sharma, 2018 ).

Apart from alexithymia and traumatic memories, high urgency (a dimension of impulsivity defined by the proneness to have strong reactions usually tied with negative affect) and being motivated to experience immersion in a virtual world would be psychological predictors of problematic multiplayer online games ( Billieux et al., 2011 ). These findings led the authors to posit that individuals with the two mentioned traits are more likely to use the immersion in the virtual world as a means to avoiding facing real life adverse issues. According to the authors, this behavior will lead to a deleterious outcome (culpability and embarrassment as a result of feeling unable to deal with problems), which in turn is experienced as a pernicious condition likely to activate behaviors related to high urgency and immersion.

Like the previously mentioned clinical issues, this vicious loop reinforcing escapism also appears to be a therapeutic target.

Considering the possible association between alexithymia and problematic gaming as a manner to regulate emotions ( Baysan-Arslan et al., 2016 ; Bonnaire and Baptista, 2019 ), the Emotion Regulation Therapy (ERT) might strengthen the therapeutic process. The aim being that the observed difficulties in Internet (including VG) addicts to identifying emotions and regulating affects ( Caretti et al., 2010 ; in Craparo, 2011 ) could be, at least partially, overcome through the ERT process. In effect, Compare et al. (2014) , show that ERT operates as a means to reappraise emotions that trigger actions leading to negative consequences. Reappraising emotions is associated with the involvement of the medial prefrontal cortex, which attenuates the amygdala activation and, thus, reduces the intensity of negative affect; these two areas being coordinated by the orbitofrontal cortex ( Compare et al., 2014 ). Since AU would be prone to associate happiness with VG play, ERT might facilitate the perceptional change enabling to link VG play with pleasure [ Caretti and Craparo, 2009 ; in Craparo (2011) consider Internet addiction (including VG) “as a syndromic condition characterized by a recurrent and reiterated search for pleasure derived from dependence behavior, associated with abuse, craving , clinically significant stress, and compulsive dependence actions despite the possible negative consequences”]. Within this approach, it may be postulated that enabling problematic gamers to familiarize with and to see the self-transcendent notion of happiness could favor the distinction between pleasure and happiness and would render them less vulnerable from impulses and from environmental circumstances ( Dambrun et al., 2012 ). The idea is to facilitate the shift from wanting more than liking (or even without liking) toward liking with little or without wanting ( Berridge and Kringelbach, 2011 ). Furthermore, regarding motives for playing, it could be posited that helping problematic gamers to identify and distinguish the emotions tied to escaping/coping from those related to recreational gaming ( Demetrovics et al., 2011 ), would be a necessary condition to orient effectively the ERT toward the escaping issues and targeted emotional states requiring therapeutic input. In this line, based on the previously mentioned studies in this section, it might be useful exploring the possible link that the excessive time spent in cyber activity could have with past traumatic experiences, insecure attachment, impulsivity, anxiety and depression.

In conclusion, this study suggests that the mentioned confusion of emotional states (pleasure and happiness) associated with addiction ( Lustig, 2017 ), could take place in subjects with VG addiction, and potentially in the entire spectrum of addictions. Moreover, from a cognitive therapeutic perspective, it shows the potential benefits of reappraising emotions as a means to contribute to the emotional distortion reduction.

Limitations

The small sample of this study demands cautiousness when making generalizations from its results. Besides, watching VG clips rather than actually playing VG might be less stimulating for chronic gamers and could have influenced the physiological values recorded during the clip visioning phases. That said, many gamers do attend to public competitions to watch other gamers playing VG. Although, to the best of our knowledge, there is no information available to affirm that there are VG addicts in these audiences.

We also faced the usual paradox when assessing craving via self-report tools. Indeed, participants were asked to judge their craving intensity for VG play whereas sensing craving often may imply a compromised self-awareness level and thus a self-assessment whose value needs to be interpreted carefully.

Although the GAS is a validated tool, which has shown its usefulness in screening addict gamers, having complemented this measurement with thorough diagnostic-driven interviews run by specialists when choosing participants to form the AU and the NAU groups would have strengthened the selection process.

The participants’ selection was centered on the gamer status (gaming addiction/non-addiction and names of games usually played) rather than on the cultural and/or educational background of the persons. Future researches could complete this approach by assessing the possible cultural and educational bias in perceiving the studied emotional states.

Moreover, including more physiological parameters related to pleasure and happiness could further complete the self-reported information and may enable reaching more robust results.

Prospective Research

Further research is required to better understand the relationship between the studied emotional states and this addiction. For instance, since VG addiction decreases with age ( Wittek et al., 2016 ) a longitudinal study could reveal the factors (psychophysiological, environmental, etc.) that operate that change. Moreover, VG addiction is only one area of the spectrum of addictions. Undertaking similar researches on other addictions and with larger samples could also contribute to deepening the comprehension of this issue. Finally, keep enhancing the scales that measure pleasure and happiness may provide with more accurate information about the range of nuances intrinsic to these two emotional states.

Data Availability Statement

All datasets generated for this study are included in the article/supplementary material.

Ethics Statement

The studies involving human participants were reviewed and approved by the Université Libre de Bruxelles Ethical Committee. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

LG developed the proposal and the conception of the original project research, searched and articulated the theoretical background, participated in the study and protocol design, elaborated the results interpretation, assembled all the chapters of the study, and in charge of the manuscript writing. ND was involved in the scientific and publication management, participated – as the Research Center Manager – in the study and protocol design, and in charge of the configuration and writing of the physiological measures. JL, as a member of the Research Center, was involved in the study and protocol design, also involved in the configuration of physiological measures, managed the experimental phases in the laboratory, and elaborated the data analysis. CL, as a full Professor at the Faculty of Psychology and Director of the Research Center for Work and Consumer Psychology, assured the scientific and publication management, participated in the study and protocol design, in charge of making the critical reviews of the manuscript along the process, and involved in the manuscript writing.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to express our gratitude to Maastricht University (Department of Psychiatry and Neuropsychology) as well as Université Libre de Bruxelles (Faculty of Psychological Sciences and of Education – Research Center for Work and Consumer Psychology). This work was performed as a partial fulfillment toward the International Master in Affective Neuroscience of Maastricht University and the University of Florence.

Abbreviations

AU, addict users; EEG, Electroencephalogram; ETR, Emotions Regulation Therapy; GAS, Gaming Addiction Scale; H, happiness; HR, heart rate; I.G.D., Internet Gaming Disorders; NAU, non-addict users; OHQ, Oxford Happiness Questionnaire; P, pleasure; SHAPS, Snaith-Hamilton Pleasure Scale; VG, video games.

Andreassen, C. S., Billieux, J., Griffiths, M. D., Kuss, D. J., Demetrovics, Z., Mazzoni, E., et al. (2016). The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: a large-scale cross-sectional study. Psychol. Behav. 30, 252–262. doi: 10.1037/adb0000160

PubMed Abstract | CrossRef Full Text | Google Scholar

Ballaine, B. W., and Dickinson, A. (1998). Goal-directed instrumental action: contingency and incentive learning and their cortical substrates. Neuropharmacology 37, 407–419. doi: 10.1016/s0028-3908(98)00033-1

Baysan-Arslan, S., Cebeci, S., Kaya, M., and Canbal, M. (2016). Relationship between Internet addiction and alexithymia among university students. Clin. Invest. Med. 39, S111–S115.

Google Scholar

Berridge, K., and Kringelbach, M. (2011). Building a neuroscience of pleasure and well being. Psychol. Well Being 1, 1–3.

PubMed Abstract | Google Scholar

Berridge, K. C., and Kringelbach, M. L. (2013). Neuroscience of affect: brain mechanisms of pleasure and displeasure. Current Opin. Neurobiol. 23, 294–303. doi: 10.1016/j.conb.2013.01.017

Billieux, J., Chanal, J., Khazaal, Y., Rochat, L., Gay, P., Zullino, D., et al. (2011). Psychological predictors of problematic involvement in massively multiplayer online role-playing games: illustration in a sample of male cybercafé players. Psychopathology 44, 165–171. doi: 10.1159/000322525

Billieux, J., Van der Linden, M., Achab, S., Khazaal, Y., Paraskevopoulos, L., Zullino, D., et al. (2013). Why do you play Warcraft? An in-depth exploration of self-reported motivation to play online and in the game behaviors in the virtual world of Azeroth. Compt. Hum. Behav. 29, 103–109. doi: 10.1016/j.chb.2012.07.021

CrossRef Full Text | Google Scholar

Bonnaire, C., and Baptista, D. (2019). Internet gaming disorder in male and female young adults: the role of alexithymia, depression, anxiety and gaming type. Psychiatry Res. 272, 521–530. doi: 10.1016/j.psychres.2018.12.158

Bradley, B. P., Phillips, G., Green, L., and Gossop, M. (1989). Circumstances surrounding the initial lapse to opiate use following detoxification. Br. J. Psychiatry 154, 354–359. doi: 10.1192/bjp.154.3.354

Bruchon-Schweitzer, M., and Boujut, E. (2014). Psychologie de la Santé: Concepts, Methods et Modèles. Paris: Dunod, doi: 10.3917/dunod.bruch.2014.01

Caretti, V., and Craparo, G. (2009). “Psychological issues of technological addiction. New diagnostic criteria for addiction,” in Annual Review of Cybertherapy and Telemedicine 2009. Advanced Technologies in the Behavioural, Social and Neurosciences , eds B. K. Wiederhold and G. Riva, (Amsterdam: IOS Press), 227–280.

Caretti, V., Craparo, G., and Schimmenti, A. (2010). “Alcune evidenze empireche sul construtto di trance dissi-ociativa da videoterminale,” in Addiction , eds V. Caretti and D. La Barbera, (Milano: Rafaelo Cortina), 167–182.

Chou, T., and Ting, C. H. (2003). The role of flow experience in cyber-game addiction. Cyber Psychol. Behav. 6, 663–675. doi: 10.1089/109493103322725469

Cipresso, P., Serino, S., and Riva, G. (2014). The pursuit of happiness measurement: a psychometric model based on psychological correlates. Sci. World J. 2014:139128.

Compare, A., Zarbo, C., Shonin, E., van Gordon, W., and Marconi, C. (2014). Emotional regulation and depression: a potential mediator between heart and mind. Cardiovasc. Psychiatry Neurol. 2014:324374. doi: 10.1155/2014/324374

Cooper, S., Robinson, A. J., and Mazei-Robinson, M. (2017). Reward circuitry in addiction. Neurotherapeutics 14, 687–697. doi: 10.1007/s13311-017-0525-z

Craparo, G. (2011). Internet addiction, dissociation and alexithymia. Proc. Soc. Behav. Sci. 30, 1051–1056. doi: 10.1016/j.sbspro.2011.10.205

Dambrun, M., Ricard, M., Després, G., Drelon, E., Gibelin, E., Gibelin, M., et al. (2012). Measuring happiness: from fluctuating happiness to authentic, durable happiness. Front. Psychol. 3:16. doi: 10.3389/fpsyg.2012.00016

Deci, E. L., and Ryan, R. M. (2000). The “what” and “why” of goal pursuits: human needs and the self-determination of behaviour. Psychol. Inq. 11, 227–668.

Deci, E. L., and Ryan, R. M. (2008). Hedonia, eudamonia, and well-being: an introduction. J. Happiness Stud. 9, 1–11. doi: 10.1007/s10902-006-9018-1

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Zilahy, D., Mervó, B., et al. (2011). Why do you play? The development of the motives for online gaming questionnaire (MOGQ). Behav. Res. Methods 43, 814–825. doi: 10.3758/s13428-011-0091-y

Dong, G., Li, H., and Potenza, M. (2017). Cognitive control and reward/loss processing in Internet gaming disorders: results from a comparison with recreational Internet game users. Eur. Psychiatry 44:3038.

Dong, G., and Potenza, M. (2015). A cognitive-behavioural model of Internet gaming disorders: theoretical underpinnings and clinical implications. J. Psychiatry Res. 58, 7–11. doi: 10.1016/j.jpsychires.2014.07.005

Dongping, L., Wenhau, Z., Xian, L., Yueyue, Z., Liyan, Z., and Yanhui, W. (2016). Stressful life events and adolescent Internet addiction: the mediating role of psychological needs satisfaction and the moderating role of coping style. Comp. Hum. Behav. 63, 408–415. doi: 10.1016/j.chb.2016.05.070

Esposito, E., Di Matteo, V., and Di Giovanni, G. (2008). Serotonin-dopamine interaction: an overview. Prog. Brain Res. 172, 3–6. doi: 10.1016/S0079-6123(08)00901-1

Gaetan, S., Bonnet, A., Brejard, V., and Cury, F. (2014). French validation of the 7-item Game Addiction Scale for adolescents. Rev. Eur. Psychol. Appl. 64, 161–168. doi: 10.1016/j.erap.2014.04.004

Geisel, O., Panneck, P., Stickel, A., Schneider, M., and Müller, C. A. (2015). Characteristics of social network gamers: results of an online survey. Front. Psychiatry 6:69. doi: 10.3389/fpsyt.2015.00069

Gil, S., and Droit-Volet, S. (2012). Emotion time distortions: the fundamental role of arousal. Cogn. Emot. 26, 847–862. doi: 10.1080/02699931.2011.625401

Gowing, L., Ali, R. L., Allsop, S., Marsden, J., Turf, E. E., West, R., et al. (2015). Global statistics on addictive behaviours: 2014 status report. Society for the study of addiction. Addiction 110, 904–919. doi: 10.1111/add.12899

Griffiths, M. (2008). Diagnosis and management of video game addiction. New Direct. Addict. Treat. Prevent. 12, 27–41.

Griffiths, M., Kuss, D., and King, D. (2012). Video game addiction: past. Present and future. Curr. Psychiatry Rev. 8, 308–318. doi: 10.2174/157340012803520414

Han, D. H., Bolo, N., Daniels, M. A., Arenella, L., Lyoo, I. K., and Renshaw, P. F. (2011). Brain activity and desire for Internet video game play. Comprehen. Psychiatry 52, 88–95. doi: 10.1016/j.comppsych.2010.04.004

Hills, P., and Argyle, M. (2002). The oxford happiness questionnaire: a compact scale for the measurement of psychological well-being. Pers. Individ. Differ. 33, 1073–1082. doi: 10.1016/s0191-8869(01)00213-6

Hull, D., William, G. A., and Griffiths, M. D. (2013). Video game characteristics, happiness and flow as predictors of addiction among video game players: a pilot study. J. Behav. Addict. 2, 145–152. doi: 10.1556/JBA.2.2013.005

Jatupaiboon, N., Pan-ngum, S., and Israsena, P. (2013). Real-time EEG-based happiness detection system. Sci. World J. 2013:618649. doi: 10.1155/2013/618649

Kandri, T. A., Bonotis, K. S., Floros, G. D., and Zafiropoulou, M. M. (2014). Alexithymia components in excessive internet users: a multi-factorial analysis. Psychiatry Res. 220, 348–355. doi: 10.1016/j.psychres.2014.07.066

Kardefelt-Winther, D. (2014). A conceptual and methodological critique of Internet addiction research: towards a model of compensatory Internet use. Comput. Hum. Behav. 31, 351–354. doi: 10.1016/j.chb.2013.10.059

Kashdan, T., Bsiwas-Diener, R., and King, L. (2008). “Reconsidering Happiness: the cost of distinguishing between hedonics and eudemonia”. .J. Posit. Psychol. 3, 219–233. doi: 10.1080/17439760802303044

Kennedy, A., Epstein, D. H., Jobes, M. L., Agage, D., Tyburski, M., Phillips, K. A., et al. (2015). Continuous in-the-field measurement of heart rate: correlates of drug use, craving, stress and mood in polydrug users. Drug Alcohol Depend. 151, 159–166. doi: 10.1016/j.drugalcdep.2015.03.024

Keyes, K. M., Jager, J., Hamilton, A., O’Malley, P. M., Miech, R., and Schulenberg, J. (2015). National multi-cohort time trends in adolescent risk preference and relation with substance use and problem behavior from 1976 to 2011. Drug Alcohol Depend. 155, 267–274. doi: 10.1016/j.drugalcdep.2015.06.031

Khazaal, Y., Chatton, A., Rothen, S., Achab, S., Thorens, G., Zullino, D., et al. (2016). Psychometric properties of the 7-item game addiction scale among French and German adults. BMC Psychiatry 16:132.

Khazaal, Y., Zullino, D., and Billieux, J. (2012). The Geneva smoking pictures: development and preliminary validation. Eur. Addict. Res. 18, 103–109. doi: 10.1159/000335083

Kim, E. J., Namkoong, K., Ku, T., and Kim, S. J. (2007). The relationship between online game addiction and aggression, self, control and narcissistic personality traits. Eur. Psychiatry 23, 212–218. doi: 10.1016/j.eurpsy.2007.10.010

Kim, H., Ha, J., Chang, W. D., Park, W., Kim, L., and Im, C. H. (2018). Detection of craving for gaming in adolescents with internet gaming disorders using multimodal bio signals. Sensors 18:102. doi: 10.3390/s18010102

Ko, C.-H., Gin-Chung, L., Sigmund, H., Ju-Yu, Y., Ming-Jen, Y., Wei-Chen, L., et al. (2009). Brain activities associated with gaming urge of online gaming addiction. J. Psychiatry Res. 43, 739–747. doi: 10.1016/j.jpsychires.2008.09.012

Koepp, M. J., Gunn, R. N., Lawrence, A. D., Cunningham, V. J., Dagher, A., Jones, T., et al. (1998). Evidence for striatal dopamine release during a video game. Nature 393, 266–268. doi: 10.1038/30498

Kowert, R., Vogelgesang, J., Festl, R., and Quandt, T. (2015). Psychological causes and consequences of online video game play. Comput. Hum. Behav. 45, 51–58. doi: 10.1016/j.chb.2014.11.074

Kringelbach, M., and Berridge, K. (2009). Towards a functional neuro-anatomy of pleasure and happiness. Trends Cogn. Sci. 13, 479–487. doi: 10.1016/j.tics.2009.08.006

Kringelbach, M., and Berridge, M. (2010). The neuroscience of happiness and pleasure. Soc. Res. 77, 659–678.

Lawrence, L. M., Ciorciari, J., and Kyrios, M. (2014). “Relationships that compulsive buying has with addiction, obsessive-compulsiveness, hoarding and depression”. Compr. Psychiatry 55, 1137–1145. doi: 10.1016/j.comppsych.2014.03.005

Lazarus, R. S., and Folkman, S. (1984). Stress, Appraisal and Coping. New York, NY: Springer.

Lee, Y., Han, D., Yang, K. C., Daniels, M. A., Na, C., Kee, B. S., et al. (2008). Depression like characteristics of 5HTTLPR polymorphism and temperament in excessive Internet users. J. Affect. Disord. 2, 165–169. doi: 10.1016/j.jad.2007.10.020

Lemmens, J., Valkenburg, P., and Peter, J. (2011). Psychological causes and consequences of pathological gaming. Comput. Hum. Behav. 27, 144–152. doi: 10.1016/j.chb.2010.07.015

Lemmens, J. S., Valkenburg, P. M., and Peter, J. (2009). Development and validation of game addiction scale for adolescents. Media Psychol. 12, 77–95. doi: 10.1080/15213260802669458

Lepine, J.-P., and Briley, M. (2011). The increasing burden of depression. Neuropsychiatr. Dis. Treat. 7(Suppl. 1), 3–7.

Loas, G., Dubal, S., Perot, P., Tirel, F., Nowaczkowski, P., and Pierson, A. (1997). Etude de validation de la version française de l’échelle de plaisir de Snaith et Hamilton. L’Encephale 23, 454–458.

Loonen, A., and Ivanova, S. (2016). Circuits regulating pleasure and happiness – mechanisms of depression. Front. Hum. Neurosci. 10:571.

Lu, D., Wang, J. W., and Huang, A. C. (2010). Differentiation of internet addiction risk level based on autonomic nervous responses: the internet-addiction hypothesis of autonomic activity. Cyberpsychol. Behav. Soc. Netw. 13, 371–378. doi: 10.1089/cyber.2009.0254

Lustig, R. (2017). The Hacking of the American Mind. New York, NY: Avery.

MacNicol, B. (2016). The biology of addiction. Can. J. Anesthesia 64, 141–148. doi: 10.1097/YPG.0000000000000095

Mahapatra, A., and Sharma, P. (2018). Association of internet addiction and alexithymia – A scoping review. Addict. Behav. 81, 175–182. doi: 10.1016/j.addbeh.2018.02.004

Mikolajczak, M., and Luminet, O. (2006). Is alexithymia affected by situational stress or is it a stable trat related to emotion regulation? Pers. Individ. Differ. 40, 1399–1408. doi: 10.1016/j.paid.2005.10.020

Orzack, M. H., Vouse, A. C., Wolf, D., and Hennen, J. (2006). An on-going study of group treatment for men involved in problematic Internet enabled sexual behaviour. CyberPsychol. Behav. 9, 348–360. doi: 10.1089/cpb.2006.9.348

Petry, N. M., Rehbein, F., Gentile, D. A., Lemmens, J. S., Rumpf, H. J., Mößle, T., et al. (2014). An international consensus for assessing Internet gaming disorder using new DSM-5 approach. Addiction 109, 1399–1406. doi: 10.1111/add.12457

Petry, N. M., Rehbein, F., Ko, C. H., and O’Brien, C. H. (2015). Internet gaming disorders in the DSM-5. Curr. Psychiatry Rep. 17:19.

Pollard, I. (2003). From Happiness to Depression”. Today’s Life Science. Available at: www.biotechnews.com.au (accessed August, 2019).

Procter, P. (1985). Longman Concise English Dictionary. England: Longman Group Limited.

Ryu, H., Lee, J., Choi, A., Park, S., Kim, D., and Choi, J. (2018). The relationship between impulsivity and internet gaming disorders in young adults: mediating effects of interpersonal relationships and depression. Int. J. Environ. Res. Public Health 15:458. doi: 10.3390/ijerph15030458

Sarda, E., Bègue, L., Bry, C., and Gentile, D. (2016). Internet gaming disorders and well-being: a scale validation. Cyberpsychol. Behav. Soc. Netw. 19, 674–679. doi: 10.1089/cyber.2016.0286

Schimmenti, A., and Caretti, V. (2010). Psychic retreats or psychic pits? Unbearable states of mind ad technological addiction. Psychoanalogy 27, 115–132. doi: 10.1037/a0019414

Schimmenti, A., Passanisi, A., Caretti, V., La Marca, L., Granieri, A., Iacolino, C., et al. (2017). Traumatic experiences, alexithymia and Internet addiction symptoms among late adolescents: a moderated mediation analysis. Addict. Behav. 64, 314–320. doi: 10.1016/j.addbeh.2015.11.002

Schmidt, L. A. (2016). “What are addictive substances and behaviours and how far do they extend?,” in Impact of Addictive Substances and Behaviours on Individual and Societal Well-Being , eds P. Anderson, J. Rehm, and R. Room, (London: Oxford Unversity Press).

Schwabe, L., Tegenhoff, M., Höffken, O., and Wolf, O. (2012). Simultaneous glucocorticoid and noradrenergic activity disrupts the neural basis of goal-directed action in the human brain. J. Neurosci. 32, 10146–10155. doi: 10.1523/JNEUROSCI.1304-12.2012

Seay, A. F., and Kraut, R. E. (2007). “Project massive: self-regulation and problematic use of on-line gambling,” in Proceedings of the ACM CHI Conference on Human Factors in Computing Systems , San Jose, CA.

Serretti, A., Calati, R., Mandelli, L., and Ronchi, D. D. (2006). Serotonin transporter gene variant and behaviour: a comprehensive review. Curr. Drug Targets 7, 1659–1669. doi: 10.2174/138945006779025419

Shen, C., Ratan, C., Dora, Y., and Leavitt, A. (2016). Do men advance faster than women? Debunking the gender performance gap in two massively multiplayer online games. J. Comput. Med Commun. 21, 312–329. doi: 10.1111/jcc4.12159

Sinha, R., Fuse, T., Aubin, L. R., and O’Malley, S. S. (2000). Psychological stress drug-related cues and cocaine craving. Psychopharmacology 152, 140–148. doi: 10.1007/s002130000499

Snaith, R. P., Hamilton, M., Morley, S., and Humayan, A. (1995). A scale for the assessment of the hedonic tone: the Snaith-Hamilton Pleasure Scale. Br. J. Psychiatry 167, 99–103. doi: 10.1192/bjp.167.1.99

Szalavitz, M. (2011). What does a 400% increase in antidepressant use really mean?. Patna: Time.

Teplan, M., and Krakovskà, A. (2009). “EEG features of psycho-physiological relaxation,” in Proceedings of the 2nd International Symposium on Applied Sciences in Biomedical and Communication Technologies ISABEL 2009 , (Bratislava: Institute of Measurement Science SAS).

Tian, Y., Liu, P., and Huang, X. (2018). The role of emotion regulation in reducing emotional distortions of duration perception. Front. Psychol. 9:347. doi: 10.3389/fpsyg.2018.00347

Torres, A., Catena, A., Megias, A., Maldonado, A., Candido, A., Verdejo-Garcia, A., et al. (2013). Emotional and non-emotional pathways to impulsive behavior and addiction. Front. Hum. Neurosci. 7:43. doi: 10.3389/fnhum.2013.00043

Tricomi, E., Ballaine, B. W., and O’Doherty, J. P. (2009). A specific role for posterior dorsolateral striatum in human habit learning. Eur. J. Neurosci. 29, 2225–2232. doi: 10.1111/j.1460-9568.2009.06796.x

Üstün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C., and Murray, C. J. (2004). Global burden of depressive disorders in the year 2000. Br. J. Psychiatry 184, 386–392. doi: 10.1192/bjp.184.5.386

van Holst, R. J., Lemmens, J. S., Valkenburg, P. M., Peter, J., Veltman, D. J., and Goudriaan, A. E. (2012). Attentional bias and disinhibition toward gaming cues are related to problem gaming in male adolescents. J. Adolescent. Health 50, 541–546. doi: 10.1016/j.jadohealth.2011.07.006

Volkow, N., Wang, G., Fowler, J., Tomasi, D., and Telang, F. (2011). Addiction: beyond dopamine reward circuitry. PNAS 108, 15037–15042. doi: 10.1073/pnas.1010654108

Wallace, B. C. (1989). Psychological and environmental determinants of relapse in crack cocaine smokers. J. Subst. Abuse Treat. 6, 95–106. doi: 10.1016/0740-5472(89)90036-6

Wang, L., Wu, L., Wang, Y., Li, H., Liu, X., Du, X., et al. (2017). Altered brain activities associated with craving and cue reactivity in people with Internet gaming disorders: evidence from the comparison with recreational Internet game users. Front. Psychol. 8:1150. doi: 10.3389/fpsyg.2017.01150

Waterman, A., Schwartz, S., and Conti, R. (2008). The implication of the two conceptions of happiness (Hedonic. (enjoyment)and Eudamonia) for the understanding of intrinsic motivation. J. Happiness Stud. 9, 41–79. doi: 10.1007/s10902-006-9020-7

Wei, H.-T., Chen, M. H., Huang, P. C., and Bai, Y. M. (2012). The association between online gaming, social phobia and depression: an internet survey. BMC Psychiatry 12:92. doi: 10.1186/1471-244X-12-92

Wenzel, H. G., Bakken, I. J., Johansson, A., Götestam, K. G., and Øren, A. (2009). Excessive computer game playing among Norwegian adults: self-reported consequences of playing and association with mental health problems. Psychol. Rep. 105, 1237–1247. doi: 10.2466/pr0.105.f.1237-1247

Whiteford, H., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al. (2013). “Global burden of attributable to mental and substance use disorders: findings from the global burden of disease study 2010”. Lancet 382, 1575–1586. doi: 10.1016/S0140-6736(13)61611-6

Wittek, C. T., Reiten Finseras, T., Pallesen, S., Mentzoni, A., Hanss, D., Griffiths, M., et al. (2016). Prevalence and predictors of video game addiction: a study based on a national and representative sample gamers. Int. J. Mental Health Addict. 14, 672–686. doi: 10.1007/s11469-015-9592-8

World Health Organization [WHO] (2018). Available at: https://www.who.int/features/qa/gaming-disorder/en/ (accessed December, 2018).

Yau, Y., Crowley, M., Mayes, L., and Potenza, M. (2012). Are Internet use and video game play addictive behaviours? Biological, clinical and public health implications for youths and adults. Minerva Psichiatrica 53, 153–170.

Yin, H. H., Knowlton, B. J., and Ballaine, B. W. (2004). Lesions of dorsolateral striatum preserve outcome expectancy but disrupt habit formation in instrumental learning. Eur. J. Neurosci. 19, 181–189. doi: 10.1111/j.1460-9568.2004.03095.x

Zheng, Y., Fan, F., Liu, X., and Mo, L. (2012). Life events, coping and posttraumatic stress symptoms among Chinese adolescents exposed to 2008 Wenchuan Earthquake. China. PLoS One 7:e29404. doi: 10.1371/journal.pone.0029404

Self-Report Questionnaires

– Six items Questionnaire: Pleasure and/or Happiness associated with VG play (Items 7 and 8 were suppressed after the preliminary phase)

(1) I enjoy playing video games.

(2) I am happy when I play video games.

(3) I would find pleasure in my video game activities.

(4) I find video games amusing.

(5) I enjoy playing my favorite video game.

(6) I often experience joy and exaltation when playing video games.

(7) I would feel pleasure when I receive praise from other people on my capacity to play video games.

(8) I don’t have fun when playing video games with other people.

fully disagree disagree slightly disagree slightly agree agree fully agree

<———I——————I——————I————————I——————I—————I———>

– Questionnaire on Craving for playing VG

– After having watched this clip I feel craving for playing video games.

– Three bipolar items Questionnaire: Pleasure and/or Happiness associated with VG play

Bipolar items.

(1) I enjoy playing video games I am happy when I play video games

I——————I——————I——————I—————I

(2) I would find pleasure in I find video games amusing my video game activities

(3) I enjoy playing my favorite I often experience joy and exaltation video game when playing video games

– Ten key words [resulting from the semantic mapping of pleasure (P) and happiness (H)]: 3/10 words to be associated with VG play

– Joy

– Craving

– Well-being

– Impulsivity

– Fellowship

– Desire

– Fun

– Contentment

– Gratification

– Serenity

Pleasure cluster: joy, craving, impulsivity, desire, fun, gratification.

Happiness cluster: well-being, fellowship, contentment, serenity.

– One bipolar item Questionnaire: Pleasure or Happiness associated with VG play (with explicit definitions)

Happiness : emotional state of lasting contentment.

Pleasure : transient emotional state when satisfying a desire, a craving.

A bipolar item

Keywords : video games, addiction, confusion, pleasure and happiness, emotional states

Citation: Gros L, Debue N, Lete J and van de Leemput C (2020) Video Game Addiction and Emotional States: Possible Confusion Between Pleasure and Happiness? Front. Psychol. 10:2894. doi: 10.3389/fpsyg.2019.02894

Received: 03 July 2019; Accepted: 06 December 2019; Published: 27 January 2020.

Reviewed by:

Copyright © 2020 Gros, Debue, Lete and van de Leemput. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lucio Gros, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

• Is Business Right for Me?
• Bachelor of Business Administration
• Business Minor
• Entrepreneurship Minor
• Real Estate Development Minor
• Course Catalog
• Electives, Minors & Opportunities
• Global Student Experiences
• Summer Business Academy
• All-Access Weekend
• Discover Ross

Ranked #4 by U.S. News & World Report, the Michigan Ross BBA Program is one of the best undergraduate business program in the world. Explore what makes our inclusive community of learners so unique.

• Which MBA Format is Right for Me?
• Full-Time MBA
• Weekend MBA
• Executive MBA
• Evening MBA
• Which One-Year Master's Degree is Right for Me?
• Master of Accounting
• Master of Business Analytics
• Master of Management
• Master of Supply Chain Management
• Global Student Experiences (graduate)
• MAP Projects & Testimonials

At Michigan Ross, you gain more than just a first-class business education. Our collaborative, supportive, inclusive community enriches your experience, and sets you up with a lifetime network of friends across the globe.

• Faculty Overview
• Faculty Directory
• Faculty News & Research
• Academic Areas
• Books & Publications
• Faculty Excellence
• Faculty Recruiting
• Centers, Institutes & Initiatives
• India Initiatives
• Technology & Business Innovation Forum
• Thomas C. Jones Undergraduate Innovation Initiative
• Tozzi Electronic Business and Finance Center
• PhD Program

The work of Michigan Ross faculty influences the world’s largest companies and global economies. Every day we’re creating real-world solutions for the most pressing challenges in our world. 

• Centers & Institutes
• Executive Education
• Alumni News
• Michigan Ross+Financial Times
• School News
• Student Voices
• Browse All Events
• Social Media
• News Archive
• For the Media
• Commencement
• Handleman Lecture Series
• William K. McInally Memorial Lecture Series
• Mitchell Lecture Series
• Full-Time MBA: Ross Women’s Weekend and UpClose Diversity Weekend

Follow a monthly poll co-created by Financial Times and Michigan Ross for insights on how American voters perceive key financial and economic issues in the lead-up to the 2024 U.S. presidential election.

• About Michigan Ross
• Mission & Values
• Diversity, Equity & Inclusion
• Key Facts & Figures
• Ross Experiences in Action-Based Learning: REAL
• Business+Impact
• Business+Tech
• Ross Around the World
• About Sharon F. Matusik
• Ross Leadership Team
• Ross School Advisory Board
• 100 Years of Michigan Ross
• Visit Ann Arbor
• Visit Detroit

Discover more about the history, people, milestones, and contributions that have shaped Michigan Ross.

New Study Explores Video Game Addiction Rates

Using data from a top video game streaming service, Puneet Manchanda, Isadore and Leon Winkelman Professor of Marketing , and PhD student Bruno Castelo Branco challenge preconceived notions of high addiction rates in the video game-playing community. 

Building off Manchanda’s previous research on addiction , the research explores a video game addiction using data on actual gaming behavior in the real world. Previous research on the addiction rate of video games has focused on individual representations of addiction through surveys and questionnaires. Rather than looking at just time played as a key indicator for addiction, Manchanda and Branco explored the rates of consumption  – whether playing video games makes you play even more. 

In their exploration of the data from the computer game streaming platform Steam , Manchanda and Branco were able to look at consumption and addictive behavior objectively.

“To consider a person addicted, our definition is that playing video games makes you want to play video games even more,” shared Branco. “Our methodological approach allows us to test each individual’s behavior separately and come up with a share of people with addiction within the gamer population.” 

Using this definition, they found that depending on the type of video game, only 14.6-18.3% of their sample of 13,400 video gamers on Steam show signs of addictive consumption. As Manchanda and Branco noted, this may be a surprising statistic depending on an individual’s relationship to the video game industry.

“If I share this with some parents, they think, ‘It's way too low, right?’ But if I share this with gamers, they think, ‘Oh, it's ridiculously high. Your definition of addiction must be wrong,’” shared Manchanda. “I found a similar situation when I started researching gambling. First, [advocates] have to agree with the number. The problem, then, is the valence around the number. Is it a positive or a negative? And that depends on your worldview, experience, who you are, and whether you are a video game player.”

One particularly impactful finding was the negligible differences in the rates of addiction between types of video games. There are many critics of the new style of ‘battle royale’ games, such as Fortnite , Apex Legends , and Valorant . Casual observers believe that the games are intentionally designed to increase addiction with bright animation and increased free access.

Manchanda and Branco shared that despite claims that some video games are purposefully designed to be addictive, they found that game characteristics are not strong predictors of addiction status.

“We look at the nuances of all the different types of games and try to correlate them with the addiction parameter, and we find that there isn’t a lot of correlation,” said Manchanda. “Based on our discussions with game designers, they all design games to be engaging. So perhaps one explanation is that all these games on Steam are meant to make you come back. So there's no differential advantage one game has over the other.” 

A better predictor of addiction is an individual’s predisposition to addictive consumption. In other words, video games are not inherently addictive because of certain design elements or genres. Rather, an individual’s specific needs are being met by video games in an addictive manner.

“While playing video games related to survival, RPG, single-player, and shooter are more correlated with addiction, game type explains very little of the addictive behavior,” shared Branco. “This suggests that addiction is mostly determined by person-specific traits.”

Additionally, the study found that the addictive subgroup of the gaming population had some unique features that separated them from the total population of gamers. For example, people classified as being addicted to video games, on average, own more games, have more friends on the platform, play longer sessions, and are more likely to purchase new games.

The questions of addictive consumption of video games, which Manchanda and Branco elucidate in their research, are ongoing. In their future research, Manchanda and Branco hope to explore avenues such as video games’ impact on rational versus irrational behavior, the ethics of video game marketing and advertising, the particular design traits of specific video games, and more.

The paper, Is Video Gaming Addictive?: An Empirical Analysis has been submitted for publication.  

Matthew Trevor, Senior PR Specialist  [email protected]

VIDEO Game Addiction

Oct 13, 2014

1.03k likes | 3.83k Views

VIDEO Game Addiction. A PowerPoint presentation by: Alyssa Schiavon (: Enjoy. Video game addiction is real.

Share Presentation

• video games
• social consequences
• makes video games
• develop effective social skills

Presentation Transcript

VIDEO Game Addiction A PowerPoint presentation by: Alyssa Schiavon (: Enjoy

Video game addiction is real.. Video game addiction is real.. Although it isn’t officially recognized as a diagnosable disorder by the American Medical Association, there is evidence that people of all ages, are facing very real sometimes severe consequences within the use of video games and computer games. Instances have been reported where users play compulsively, isolating themselves from family and friends. There is no diagnosis of video game addiction in current medical or psychological disorder.

Emotional Symptoms There is no diagnosis of video game addiction in current medical or psychological disorder. • Some symptoms of addiction are • salience • mood modification, • Tolerance of violence • withdrawal, • conflict, • and relapse

Addiction Video game players like to spend most of their free time, playing video games. But for some people, what starts out as an innocent video game player becomes an addiction. Soon, friends, family, and school are neglected every spare moment spent is playing video games.

Addiction What makes video games so addictive is that they designed them kind of like casinos. They allow players to have small “wins” that can keep them playing, and then it can turn into a big win. There are different “hooks” that are built in the video games with the intent to make them “addictive”.

Most addictive What can be especially addictive is MMORPGs, also known as Massive Multiplayer Online Role-Playing Games. The reason why this is probably the most addictive is because there is no ending. What do you try and do when your on a video game? You usually try to beat your score that you played last with, or try to beat the game.. Right? Well that’s why you are so addicted to them, because they make you play them more!

Physical Consequences of Gaming Addiction You finally found a new passage way to the next level. You’re so excited that you barely notice the pain in your, nor notice your on the verge of getting a headache.. Again. You may also suffer other consequence's such as carpal tunnel (which is caused when the main nerve between the forearm and hand is squeezed or pressed. It may get swollen or irritated.) , migraines, sleep disturbances, backaches, eating irregularities, and poor personal hygiene. When I mean personal hygiene I mean you aren’t taking showers regularly, brushing your teeth, combing your hair, and other things you may need to do.

Social Consequences of Gaming Addiction People are to busy playing there games that their personal relationships get neglected and sometimes disappear altogether. Its not just neglect that cots addicted gamers their relationships. Some people talk about their game, and what its about so much that people no longer want to be around them. They won’t/can’t get into the real world conversations or be a source of support or encouragement to friends and family. Because their friends are talking about something else and they may feel left out, or un-wanted. An addicted teenager won’t develop effective social skills, which won’t help him when her wants to hangout with friends, girls/or guys, or just hangout and enjoy peoples company. The social awkwardness created by the addiction then comes in..

Violence of Video Games The most popular games used today are “COD-1-2-3-4” “ “ Grand Theft Auto” “Syndicate” “Kingdoms of Amalur: Reckoning” & etc. Usually in these games you are a U.S or British soldier who is sent to the military to defeat the worlds most dangerous and strongest enemies. As the violence in video games increase, so has the concern for the effects on those who play. Many of the school shootings in recent years have been carried out by avid gamers, their games of choice were dark, and very violent.

Treatment Options for Video Game Addicts. • A therapist or treatment • Maybe if you join a school sport or hobby like swimming or dancing, different sports out of school • Go into a summer camp or wilderness program that will get you back into the environment, and social life. • Talk to people who have the same problem, and resolve it together.

Resources' • http://www.video-game-addiction.org/ • http://en.wikipedia.org/wiki/Video_game_addiction • http://www.video-game-addiction.org/what-makes-games-addictive.html • http://www.video-game-addiction.org/physical-consequences.html • http://www.video-game-addiction.org/social-consequences.html • http://www.imdb.com/search/title?sort=moviemeter,asc&title_type=game&year=2012,2012 • http://www.video-game-addiction.org/violence.html • http://www.video-game-addiction.org/video-game-addiction-treatment.html

• More by User

Computer Game Addiction

Table of Contents. A brief introduction into Online Computer GamesHow online computer games can be addictiveExplanation on the factors of online gaming which facilitate addictionsWhy Addiction is a ProblemEthical AnalysisConcluding thoughts. Introduction to Online Games. 3 Primary Online Games:World of WarcraftFinal Fantasy XI OnlineEverQuestThese are called MMORPGs

738 views • 28 slides

Video Game Addiction

Video Game Addiction. Don’t Let It Happen To You!. What is Video Game Addiction?. Addiction is defined as “A primary, chronic disease, characterized by impaired control over the use of a psychoactive substance and/or behavior.”

682 views • 11 slides

[ online game addiction ]

[ online game addiction ]. What is online gaming?. Games played over some form of computer network (Internet) Ability to connect to multiplayer games Single-player online games are also common . World-wide “problem”. South-Korea USA Norway. Counter-Strike. Commonly abbreviated to CS

3.87k views • 14 slides

Game addiction

Game addiction. By Ernie. Call of Duty games. Game addiction is when you play game every day for more then 5 hours . Sonys new ps4 coming out . infinity ward Games.

366 views • 10 slides

Video Game Addiction. By: Spates, Kelly. Statistics . Video game industry makes more money each year then Hollywood. The American Medical association says 90% of kids today play video games. As many as 5,000,000 of those kids play so much that doctors are considering it a disorder.

391 views • 13 slides

Video Game Addiction. By the beautiful and talented Michaela Reist . . Advantages of Playing Video Games. Work better in team activities Boast your creativity Learn how to make fast decisions Improved hand-eye co-ordination Some games increase kids self confidence

673 views • 13 slides

Video Game Addiction . Are you addicted?. Facts about Video Game Addiction. Video Game addiction is an extreme use of computer and video games interfering with your daily life. People who have video game addiction isolates themselves from their family and friends.

821 views • 9 slides

Video Game Addiction. By; Meghan Kraakman.

394 views • 11 slides

Video Game Addiction. Created by Zachary Hayes, Justin Barnhart, Tyler L ayton. Summary. Some people think video game addiction is a metal disorder. Also some doctors say that video games are addicting as drugs and alcohol. All ages can and are becoming addicted to video games.

385 views • 5 slides

Video game addiction

By Issak Tremblay. Video game addiction. Hope you enjoy . Advantages and Disadvantages to video games . Advantages Gain creativity Gain better eye hand coordination Some video games gives kids self confidence You get your anger out . Disadvantages Can damage eyesight

552 views • 10 slides

Video game addiction. By felicity Verbeek. How video game addiction can affect you. Video game addictions can cause (couch potato) lake of eating sometimes, because some people just sit there and play for hours without out eating.

364 views • 10 slides

VIDEO GAMES ADDICTION

VIDEO GAMES ADDICTION. A presentation by Bilal, Peter, Malcolm and Anna Sojung Lee. What Is video game addiction?.

343 views • 10 slides

Video game addiction. Preoccupation

233 views • 10 slides

Video Game Addiction!

Instances have been reported in which users play compulsively, isolating themselves from family and friends or from other forms of social contact, and focus almost entirely on in-game achievements rather than other life events. Video Game Addiction!.

462 views • 11 slides

Game addiction. Central idea : Lifestyle choices and social pressure affect human health An inquiry into : video game addiction rehabilitation. How many get cured. About 7 of 10 thet get help are completely cured

355 views • 15 slides

Video Game Addiction. The Knights Diamoneek McDougald. What is it?. Video Game Addiction is someone who constantly plays video games Likes virtual life better than real life MMORPG are massive multiplayer online role playing games WOW (World of Warcraft ) is the biggest addicting game

1.05k views • 61 slides

Video Gaming Addiction

Video Gaming Addiction. Is it really worth it?. A PowerPoint presentation by Lilian Osborne. Video Gaming in the Past:. Video games have changed a lot since they first came out. Home video games only came out during the third generation of video game consoles.

488 views • 11 slides

Spyware, Video game addiction and netiquette

Tech-Knowledge G$$. Devon C. Floyd Alyric Knight Brain Vanhook 10/28/10 6/7. Spyware, Video game addiction and netiquette . Vide Game Addiction.

600 views • 44 slides

Tech-Knowledge G$$. Devon C. Floyd Alyric Knight Brain Vanhook 10/28/10 6/7. Spyware, Video game addiction and netiquette. Vide Game Addiction.

591 views • 44 slides

Teen Video Game Addiction

Teen Video Game Addiction. By Marcus Dixon &amp; Stiv Deleon. Video Game Addiction No Fun @ http :// www.webmd.com /mental-health/features/video-game-addiction-no-fun. What Is Addiction?. Addiction is when a person craves something and feels like they need it all the time

564 views • 8 slides

Video Game Addiction Does Exist!

Video Game Addiction Does Exist!. By : Spates, Kelly. http:// www.youtube.com/watch?v=tp3HpcPHTBA. Main Points:. Determine the different levels of game playing Games that are more likely to addicting Signs of addiction Reasons why video game addiction is bad Controlling the problem.

318 views • 10 slides

Video Game Addiction. Heather Titus. Video Game Addiction. Over the last decade, the concept of internet addiction has grown in terms of its acceptance as a legitimate clinical disorder needing treatment Excess video gaming is identified as a subtype of internet addiction

1.08k views • 21 slides

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Proc Natl Acad Sci U S A
• v.114(17); 2017 Apr 25

News Feature: Is video game addiction really an addiction?

Adding video gaming to the list of recognized behavioral addictions could help millions in need. It could also pathologize a normal behavior and create a new stigma.

Science fiction is replete with notions of losing oneself inside a digitally generated alternate reality. But for millions around the world, that dystopic vision could be very real.

Mounting neurological evidence suggests that video games may act like traditional substances of abuse. But some researchers remain unconvinced that gaming can constitute an “addiction.” Image courtesy of Shutterstock/eranicle.

Many governments already see excessive, compulsive playing of online video games, such as League of Legends and World of Warcraft , as a serious adolescent public health issue and have established treatment facilities, especially in China and South Korea ( 1 ). The adverse effects of teens’ “addiction” to the games are not just time lost studying or socializing with their peers. Some evidence associates video game addiction with depression, attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder ( 2 ). Whether there is a cause-and-effect relationship remains unclear.

As in the case of patients diagnosed with other addictions, so-called Internet Gaming Disorder (IGD) affects those around them, too: in extreme cases, it has reportedly resulted in household violence by children against their parents, who are trying to take away their games, according to Philip Tam, a psychiatrist with the not-for-profit Network for Internet Investigation and Research Australia in Sydney. “A lot of child psychologists say, we’ve got parents living in fear of their kids,” says Tam.

Whether video games can produce a true addiction in a clinical or scientific sense is still highly controversial. Can a game be considered an intoxicant? The neurological evidence is growing that games may act like traditional substances of abuse, with compelling similarities between the effects of drugs and of video games on the minds of users ( 2 ). But many worry that labeling teenagers “addicts” will pathologize behavior that is normal, and lead to false epidemics of other compulsive behaviors, such as sex and eating.

“I don’t know that there’s any consensus in this field right now,” says Nancy Petry, a professor of medicine at the University of Connecticut in Farmington, who was on the American Psychiatric Association committee that considered adding IGD to the latest diagnostic manual but decided to wait. “Personally, I think it really likely is a mental disorder, but I think we need to better quantify what it is we’re studying.”

Subtle Distinctions

Throughout the 1970s and 1980s, the word “addiction” in a medical setting referred strictly to substances, such as alcohol, tobacco, and drugs, if it was used at all. Before 2013, “addiction” did not appear in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the working dictionary of mental health. Alcohol and substance abuse were simply called alcohol- or substance-related disorders, and a diagnosis hinged on the presence of symptoms such as craving, tolerance, and withdrawal. On the other hand, pathological gambling was considered an inability to resist impulses, along with disorders like pyromania (setting things on fire), kleptomania (compulsive stealing), and trichotillomania (compulsive hair-pulling).

But over the past 15 years, the idea that it is possible to become addicted to a behavior has gained traction, especially after neuroimaging began to show that behaviors such as gambling could activate the brain’s reward system in the same way as drugs. “I think there are some people that are still holding out,” says Howard Shaffer, professor of psychiatry at Harvard Medical School in Boston, and director of the Division on Addiction at the Harvard-affiliated Cambridge Health Alliance. “But I think the evidence is pretty overwhelming now that all kinds of things can change neurochemistry. It simply doesn’t require the ingestion of drugs.”

The DSM has begun to reflect that. The authors of DSM-5, released in 2013, created a category for “substance-related and addictive disorders” that included gambling disorder, the first behavioral addiction to appear in the same class as substance addictions ( 3 ).

Video games were also considered for inclusion, but the working group decided there wasn’t enough evidence—yet ( 4 ). But the group did identify IGD in an appendix as worthy of more study and proposed a set of criteria for diagnosis. “I would say that it certainly merits exploration,” says George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

Classification as a psychiatric diagnosis in the DSM requires clearing a very high bar, one in place to prevent the proliferation of mental disorders, Petry notes. “Certain things that were once considered mental disorders—like homosexuality—no longer are, and that’s a good thing.”

Petry is one of many researchers who say that more data are needed to show both that IGD persists in patient’s lives and that it is a unique condition, not caused by preexisting, underlying mental health issues. “I don't think that body of research has made that clear,” says Chris Ferguson, a professor of psychology at Stetson University in DeLand, Florida. “Some people who are depressed stay in bed all day, but we wouldn’t say that they have a bed addiction.”

Thousands of people attend the annual League of Legends video game world championship competition in person and millions more view it online. Image courtesy of Flickr/Chris Yunker.

Pathways of Addiction

Arguments for video game addiction dovetail with the recent evolution in the concept of addiction itself: evidence that what causes the patient to lose control is not the substance itself, but the underlying neural circuitry that fires when presented with the reward the substance provides.

At the center of this understanding of addiction is the brain’s reward system, in which using the substance triggers release of the neurotransmitter dopamine, which influences neurons in the nucleus accumbens, as well as other brain areas, such as the prefrontal cortex. Repeatedly activating these complex circuits modifies neural connections until these circuits respond to mere anticipation of the reward—as in Pavlovian conditioning—and produces the classic symptom of craving. Over time, the changes in dopamine receptors and the functioning of these pathways can diminish the sense of pleasure and produce tolerance.

At the same time, dopamine exposure forges changes in other brain areas, such as the amygdala, and this can lead to a boost in negative emotions, such as fear and stress in the drug’s absence, leaving addicts seeking the drug simply to escape the pain of withdrawal. These changes in neural circuitry wrought by drug use persist, says Nora Volkow, director of the National Institute on Drug Abuse, and they go some way toward explaining why so many addicts relapse ( 5 ).

This model treats addiction as a brain disease, not a moral failing. As with other diseases, individuals may be more or less prone to it based on a complex—and so far, largely undetermined—mix of genetic and environmental factors. Although the neurobiological approach does have its critics ( 6 ), proponents, including Volkow and Koob, suggest the model could explain addiction in general and its emotional side effects, leading to new medications to treat addiction, some of which are being tested ( 7 ).

“In drugs, the person gets activated when they see that syringe or they see that dealer,” says Volkow. In video games, it may be the burst of speed from a successful trick or the cry of a defeated enemy. “It is exactly the same circuitry that gets involved,” she says. In 2001, a key study in Neuron led by Hans Breiter of Massachusetts General Hospital in Boston used fMRI to show that gambling could activate reward centers in the same way as a substance ( 8 ). Neuroimaging studies of video gamers are more recent, but show many similarities, Volkow adds. One 2011 fMRI study led by Simone Kühn, of Ghent University in Belgium, of 154 14-year-olds found that frequent gamers had more gray matter in the left ventral striatum, a change that may result from increased dopamine release that also shows up in those addicted to gambling ( 9 ).

With video games, as with gambling, the intermittency of the reward only heightens its conditioning power. “You don’t know when you will be able to kill the adversary or find the treasure that the video game is offering—but there is that moment when you do,” says Volkow. “That becomes reinforced. Because it’s actually something that you did well, dopamine goes up and it keeps you going.” Nor does the challenge need to be especially complex or gory.

“ Candy Crush is a very interesting game,” Volkow offers, referring to the mobile game published by Activision Blizzard, in which players try to arrange a grid of brightly colored candies into rows and columns; align them in the right pattern and they disappear with a visual poof, a chime, and a cascade of new candies to take their places. Volkow recalls boarding a flight this summer: “I would say 30% of the plane was playing this Candy Crush . And they would have these little sounds and colors. So you get conditioned to that sound and the color, and those become reinforcing. And that’s exactly how our brain works.”

Some developers take it even further, notes Philip Tam, with trained psychologists on staff to “tweak the gameplay, not make it too hard, to keep [players] in the zone” ( 10 ). In an influential 2001 article on the gaming industry website Gamasutra, then-psychology graduate student John Hopson deconstructed game design through the lens of behavioral psychology, introducing developers to language, such as “reinforcers” (game rewards: for example, advancing to higher levels or collecting new tokens or treasures) and “contingencies” (the game rules that govern when reinforcers are handed out) ( 11 ). Hopson presaged the increasingly complex rewards and achievement systems that nearly all big-budget games now implement, and that Hopson himself would later apply in games such as Destiny as a researcher for game studio Bungie (see www.gdcvault.com/play/1016539/Behavioral-Game ). There is little to no research, however, on whether these specific awards systems contribute to cases of video game addiction.

Another way in which games may provoke an addiction-like cycle is through the march of technology: as manufacturers and developers create more powerful equipment and deliver better graphics, gamers take part in more immersive and novel experiences, mirroring—intentionally or not—drug users seeking stronger and stronger substances. “Today’s World of Warcraft is tomorrow’s Pong ,” says Shaffer.

Virtual Realities

Concern about video game addiction is perhaps most prominent in east Asia, where many feel that games offer such a vivid alternative reality that young, developing brains are being altered in unprecedented ways by spending so much time there, and that these changes may be components of a new type of addiction.

Tae Kyung Lee, a psychiatrist at Korea’s National Mental Health Center in Seoul, who oversees a government-funded treatment clinic for adolescent gamers (see Sidebar), bases his therapy around the observation that many of his patients who can’t control how long they play also have a disrupted sense of time in the game, implying a sort of virtual time warp. “Just 3 or 4 hours passes in real time, but they feel they have spent thousands of years finishing the game,” he says. Even when they’re not playing, many gamers also experience artifacts from virtual worlds—sounds, vision, or trained reactions—bleeding into the real world.

In 2010, Angelica Ortiz de Gortari was a Master’s degree student in Stockholm researching internet addictions. “I’m no hardcore gamer,” she says, “but I used to play.” For research, she picked up Resident Evil , a survival horror series in which players fend off zombies and biological terrors. Then one day in a supermarket, she looked down the aisle at a distant item and found herself involuntarily trying to call up a virtual sniper scope to see further, just as she would in the game.

Struck by her reaction, Ortiz de Gortari refocused her thesis to understand what had happened, which she refers to as game transfer phenomenon (GTP). In her interviews, she found that gamers reported a wide variety of examples of virtual worlds bleeding into real life. One person reported seeing floating health bars above their opponents while playing soccer; others said they felt their bodies begin to strafe from side-to-side as if controlled by a joystick. In a 2015 study of 2,362 gamers, Ortiz de Gortari, now at the University of Liège in Belgium, and her coauthors reported that 97% of the gamers reported having experienced GTP ( 12 ). And in a study published in 2016, she and her colleagues found that people with severe GTP are more likely to have problematic or addictive gaming habits ( 13 ).

The connection is still tentative, says Ortiz de Gortari; it’s not clear that addiction and GTP share the same neurological pathways. Nevertheless, in 2015, the South Korean Ministry of Health and Welfare created a public service announcement urging gamers to look for signs of GTP in their lives as a marker of addiction (see https://www.youtube.com/watch?v=D7Suuxeqjo4 ).

Ortiz de Gortari says new virtual reality gaming, for example with Oculus Rift and Sony PlayStation headsets, could lead to increased GTP and other cognitive and perceptual changes. But the intensity of the experience might push virtual reality gamers to shorter overall sessions, a sort of self-regulating effect.

Redefining Addiction

Although evidence continues to mount that gaming affects the brain, and may “rewire” it in some of the same ways as other addictive drugs and behaviors, some still question the equivalence between video games and substances.

Doug Hyun Han, a researcher at Chung-Ang University Hospital in Seoul, opposes classifying IGD as an addiction, partly because hardly any of the thousands of patients he has treated exhibit tolerance or withdrawal symptoms, a more traditional, pharmacological-based distinction. Han views video games not as an intoxicant, but something neutral that children are drawn to because their young minds seek novelty and cognitive complexity. Like millions of his countrymen, Han spent his teenage and college years playing StarCraft . “I am a good gamer, you know! I loved that,” he laughs. “Now, I don’t like StarCraft anymore because I am old. I like just very simple games, very casual games, because my brain is too old to respond to complex games.”

Han considers IGD to be an impulse-control disorder, even as he admits that he’s “in a very small minority.” But he bases his distinction, in part, on a recent series of fMRI findings he’s made with colleagues. One study finds weakened connectivity between the frontal lobe and basal ganglia in gamers with IGD. That’s the opposite of what’s seen in alcohol-dependent patients, and more similar to disorders, such as ADHD ( 14 ). Problematic gamers also

“That's always been the problem with these behavioral addictions. Where do you draw the line?” —George Koob

have increased activity between the dorsolateral prefrontal cortex and temporoparietal junction, a characteristic found in people with schizophrenia, autism, and poor impulse control ( 15 ). This kind of evidence could suggest that youngsters with existing behavioral or cognitive problems are more likely to be drawn to the escapist fantasy world of games, perhaps even as a form of self-medication. But ultimately the gaming would be a symptom, not a cause of the other problems.

Another reason some oppose classifying IGD as an addiction is the term’s derogatory connotation. “I don’t think it’s in anyone’s interest to label a 13-year-old who’s screaming, wanting to play Minecraft as an ‘addict’,” says Tam.

Many also argue that criteria currently in use overdiagnose the disorder, especially those based on traditional concepts of addiction. More than a dozen different sets of diagnostic criteria have been proposed by researchers, and the ones that take a “pathological gaming” approach produce an average prevalence of 9%, according to a 2011 study in the Journal of Psychiatric Research ( 16 ). “Personally, if that really was the case, I’d expect to see a video game addiction treatment center in every major city up and down America, but that’s obviously not the case,” argues psychologist Mark Griffiths of Nottingham Trent University, United Kingdom. “I passionately believe that video game addiction exists,” says Griffiths, one of the topic’s earliest and most prolific researchers. “I just don’t think it exists on the scale that most of the literature would have you believe.”

Furthermore, no set of diagnostic criteria has gained widespread acceptance. A study published this March in the American Journal of Psychiatry that found up to 1% of the general population would fit the DSM criteria for addiction, but found little evidence of impairment ( 17 ). “They’re not good symptoms,” says Ferguson. “I am absolutely convinced that as it’s currently being defined by the DSM, this Internet Gaming Disorder thing is absolute crap.”

For some clinical psychiatrists, the debate is moot. “In a sense, I don’t care about the definition, whether it’s an addiction or what’s happening at a neurobiological level,” says Tam. “What interests me is what’s happening to the client in the real world.”

The next opportunity for researchers to define the disorder comes in 2018, when the World Health Organization (WHO) will release the 11th edition of the International Classification of Diseases (ICD). Last year, the WHO floated a hotly debated proposal to include “Gaming Disorder” in a category titled “Disorder due to addictive behaviors” in the ICD-11. “At this point, suggesting formal diagnoses and categories is premature,” stated a paper in the Journal of Behavioral Addictions . “The ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world” ( 18 ).

Some skeptics question whether video games are being pushed for inclusion faster than other potential behavioral addictions—like food and sex addictions—because of media hype or politics, where video games have often been a useful foil. “I think people in some ways have gotten kind of addicted to video game addiction,” says Ferguson. “They just can’t let go of this concept even though it’s fairly problematic.”

If IGD is included in the next revision of either the ICD or the DSM, there is concern that floodgates will open to other disorders, such as sex and food addictions, many of which also show evidence of activating the brain’s reward system but exhibit even fewer of the traditional addiction markers, such as tolerance and withdrawal. Some, like Griffiths—who works from a set of criteria that consists of tolerance, withdrawal, salience, mood modification, relapse, and conflict with others—have no problem with that. “I don’t care what the behavior is; if any behavior fulfills those six criteria, then I operationally define that person as addicted to that activity.” But others are wary.

“That’s always been the problem with these behavioral addictions,” says George Koob. “Where do you draw the line? There are those who will argue that compulsive sexual behavior can be addiction-like and others that consider it a joke.” But, he adds, “Anything that’s causing—in my view—pain and suffering and manifests itself as a pathology deserves some attention.”

South Korea’s Gaming Obsession

In the late 1990s, the South Korean government led a push to bring the Internet to the masses. The result: The country led the world in broadband penetration by the early 2000s. That fueled the birth of e-sports, centered around StarCraft , a sci-fi real-time strategy game played at a professional level in live matches and by legions of mostly teenaged boys at the ubiquitous gaming cafes known as “PC bangs.” Soon, concern rose that some were addicted.

“We know there are lots of problems for [the addicts],” says Tae Kyung Lee, a psychiatrist at Korea’s National Mental Health Center in Seoul, who oversees a government-funded treatment clinic for adolescent gamers. “They drop out of school and they seclude themselves in their homes. If we cannot handle this issue, our society will face big problems.”

The government’s role in creating this culture partly explains why politicians felt it necessary to step in to harshly regulate the gaming industry: in 2011, South Korea enacted a “shutdown law,” which tied game accounts to users’ national ID and forced children under 16 off the servers from midnight until 6:00 AM. Critics say it hasn’t worked—kids stole their parents’ IDs to get around it—and a 2014 study by Wookjoon Sung at Seoul National University found it had made no difference in the amount of time spent playing ( 19 ).