Chinese gamers and medical experts discuss gaming disorder

By Li Lin Source:Global Times Published: 2018/4/13 16:58:39

A Chinese woman plays Playerunknown's Battlegrounds. Photo: Li Hao/GT

Zhang Huijie, a 29-year-old sales manager living in Beijing had a conversation with his mother recently, and her words scared him.

"Seriously, five years ago when you were addicted to internet games, your father and I thought about sending you to a hospital or institution to treat internet addiction because we both thought you were mentally sick," she said.

Zhang spent a lot of his early 20s playing an internet game called Zheng Tu. He spent almost all of his money playing the game. "I was crazy at that time, and if my parents had sent me to that kind of institute, I would not have been surprised," Zhang said.

He doesn't play computer games anymore because he is busy with work, but his parents still get anxious when they see him play mobile games like King of Glory. They said they worry about him falling prey to game addiction. Zhang thought his parents' concerns were preposterous, but now there is a theory back up their fears.

According to a recent report by New Scientist magazine, the World Health Organization (WHO) has listed "gaming disorder" among the list of disorders in the first draft of the International Classification of Diseases (ICD), and it could be listed as a mental disorder in the near future.

The news triggered heated discussions and Chinese social media platforms were abuzz with talk around child and teenage behavior, parenting and so-called special schools for internet and gaming addiction and disorder.

What is gaming disorder?

According to the draft, one feature of gaming disorder is playing internet games or video games continuously or too frequently. How long one plays, the intensity with which the individual plays, and their mood during or after gaming also play a key role in evaluating whether he or she has gaming disorder. Another critical indicator is whether the individual prioritizes playing games over other important issues and daily activities.

According to the WHO, the pattern of gaming behavior can be "continuous or episodic and recurrent," meaning it could be noticeable every day or during certain periods, and at least 12 months of observation is necessary for a conclusive diagnosis. However, if the addictive behavior is obvious and severe, the time can be shortened.

Tang Mengjuan, a Beijing-based psychologist who specializes in teen behavior and family issues, told Metropolitan that as far as she knows, disputes around whether gaming addiction can be called a mental disorder have existed for a long time.

"As far back as 2007, when smartphones and mobile games were not that popular, some medical experts called for listing video game addiction as the same kind of mental disorder as alcohol abuse disorder," Tang said. "But the idea was not widely accepted."

Tang said nowadays the ICD and the Diagnostic and Statistical Manual of Mental Disorders (DSM) are the most commonly accepted systems of diagnosis around the world. According to the American Psychiatric Association's 2013 report in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), internet gaming disorder is a condition that warrants more clinical research and experience before it could be considered for inclusion in the main book as a formal disorder.

The report said that recent scientific reports have begun to focus on the preoccupation some people develop with certain aspects of the internet, particularly online games. The gamers play compulsively, to the exclusion of other interests, and their persistent and recurrent online activity results in clinically significant impairment or distress. People with this condition endanger their performance in school or at work because of the amount of time they spend playing and experience symptoms of withdrawal when they are prevented from playing.

The American Psychiatric Association report listed nine symptoms to help diagnosis. Only if a gamer has five or more can he or she be diagnosed with gaming disorder. They are: if the individual focuses on nothing but games; if the individual becomes worried, anxious and irritable when they stop playing; if the individual constantly increases the duration of gaming time; if the individual cannot reduce playing time or quit playing; if the individual abandons other activities and loses interest in previous hobbies; if the individual continues to play after understanding the negative effects of excessive playing; if the individual hides the amount of time they spend playing from family and friends; if the individual plays to release negative emotions; and if the individual loses their job or fails to socialize due to game play.

A gamer plays a mobile game. Photo: Li Hao/GT

Dissenting voices

Zhang is against the trend that sees addictive gaming as a mental disorder. "I think it is the same as drinking. Almost every Chinese drinks, and only a few get addicted," he said.

Zhang's concerns are not rootless. In March, a scientific report reviewing a survey on thousands of adult gamers in the US, the UK, Canada and Germany published by the American Journal of Psychiatry found that only 0.3 to 1 percent of the gamers met the gaming disorder's standard and over 65 percent of the surveyed gamers had none of the nine symptoms at all. Additionally, their mental state, physical health and social activities did not exhibit any obvious difference from non-gamers.

Wang Ming (pseudonym), a 33-year-old postdoctoral psychology student at a Beijing-based university, is a game fan himself. He said DSM is not as authoritative as many people think and that the connotations of DSM cannot reflect every aspect of a psychopathology case, like the influence of people's complicated emotions and the complicated social functions of interpersonal relationships.

"We do not have a lot of reliable evidence to check the DSM standards, and they often change with the time," said Wang. "For example, homosexuality used to be listed as a mental disorder in the 1970s in DSM, and now it is not."

Wang said gaming disorder still lacks many important epidemiological features to be listed as a mental disease, like accurate morbidity, the course of the disease and biological factors.

"I think further studies still have to be done to prove that gaming disorder is a disease, and more research on neuroscience and psychology have to be done," Wang said. "It is very harmful to identify a phenomenon as a disease."

Tang said maybe the standard of the American Journal of Psychiatry is very similar to China's first Internet Addiction Clinic Diagnosis Standard issued by the General Hospital of Beijing Military Region in 2008, which was renamed the Army General Hospital of PLA (People's Liberation Army) in 2016.

"China is the first country to issue an official diagnosis standard for internet addiction in the world," Tang said. "I don't know whether it is good."

Tao Ran, director of the country's first internet addiction treatment clinic under the Army General Hospital of PLA said many gamers, especially children and teenagers have a negative change in brain function due to playing for long periods.

"Playing games doesn't require too much thinking, and only a few areas of people's brain work [during game play]. After a long time, other functions like the social function of the brain worsen, and people's ability to focus and express emotions will degenerate," Tao told news portal recently. "If a person plays internet games for over six hours a day, their brain will become damaged in six months time."

According to the report, Tao publicly claimed that the internet addiction treatment clinic's diagnosis standard was included in section three of the DSM-5 and "was recognized internationally." However, section three is only a suggestive appendix to encourage further scientific and medical study and not a guide for clinical treatment. Page 783 of the document states that only section two pertains to diagnosis standards that are internationally recognized and can be referred to in clinical treatment.

Tang said internet addiction and gaming disorder are controversial because medical experts are still not sure whether the addiction should be viewed as a symptom of other mental disorders or an independent illness.

Wang agreed. He said many children with gaming disorder or internet addiction have Attention Deficit Hyperactivity Disorder (ADHD).

"If gaming disorder is not actually a disease, the trend of viewing it as a disease can blanket the real problem. Also, treatment for internet addiction in China is not cheap and can be rather embarrassing and painful for both the 'patients' and their families," he said.

Tang said serious internet addiction studies mostly concentrate on Asian countries and regions and not many exist in the West. In the West, the term internet addiction is not a formal term and not as well received as in China, he explained.

"I think most of the research on internet or gaming addiction do not provide a 100 percent objective survey methodology, and the results are very much likely to be affected by random elements like family environment, school bullying, nutrition and so on," Tang said. "So, I don't know why researchers are so sure that the internet and games are the root of all evil instead of other possible social reasons."

Wang said even if gaming disorder is identified as a mental disorder someday, because the proportion of gamers who really need help is very small, ordinary gamers need not worry about it. Gaming disorder currently accounts for less than 1 percent of all gamers, according to the American Journal of Psychiatry Research. He said even if one is diagnosed with gaming disorder, it doesn't mean that the person has mental problems.

"I think more research and public attention on gaming disorder is a good thing," he said. "It is a sign of progress, and it will provide a more targeted and detailed treatment for people who need help. We must be against illegal and rude 'treatment' measures, especially those targeting children and teenagers."


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