Addiction to video games, only virtual?

Video games are widely practiced. Questions about the health risks they can cause arise, particularly about the risk of addiction. While there is currently no official diagnosis of video game addiction, the DSM-5 offers provisional criteria based on those of gambling addiction. Addiction to video games affects a minority of individuals at risk. The treatments offered are essentially psychotherapeutic. The emphasis is on the fact that video games can be played in a non-problematic way and that they can also have potential beneficial effects on individuals. It is therefore recommended, when evaluating a risky practice of video games, to take into account the positive and negative impacts of this use in a nuanced way.

Introduction

The practice of video games is essential today. If the first video games were reserved for a niche of computer enthusiasts, very quickly their commercial success affected all layers of the population. Today, with the penetration of the smartphone market and generalized internet access, the use of video games is becoming more democratic. In the United States, the Entertainment software association produces an annual report on the use of video games.* In 2016, 63% of households surveyed had at least one individual who played video games 3 hours per week or more, the average The player's age is 35 and the most popular games are the so-called casual games (puzzle, cards, etc.).

As soon as a practice becomes popular, social issues appear, in particular the impact of these practices on health. In this article, we will focus on the potential risk of misuse and addiction of video games.

Video games, definition

With technology, video games have become more complex and attempts at classification can become laborious. Wikipedia offers a general definition: "electronic game that involves human interaction with a user interface for the purpose of generating visual feedback on a video device". It is then necessary to know on which medium they are practiced: computer, game console, smartphone. These supports can be online (connected to the web with the possibility of playing with other players) or offline (players against the artificial intelligence of the game). The games are then categorized by genre. Here is a list of the most popular genres and potentially the most at risk of misuse:

Massively multiplayer online role-playing games (MMORPG): players embody an avatar that will progress by completing quests in interaction with other players. Players are grouped by guild (example: World of Warcraft).

Multiplayer Online Battle Arenas (MOBA). These are fighting games where two teams of 3 to 5 players compete in matches on a defined field (example: League of Legends).

First-person shooter (FPS): players embody an avatar in subjective vision. These games are based on the fights of these avatars (example: Call of Duty).

There are other categories like simulators, platformers, etc. We will see in the next chapter that depending on the type of game, the risk of developing misuse is greater or lesser.

Risk of developing an addiction to video games

Any substance or behavior that has the potential to lead to addiction will act on the center of reinforcement:1 addictive substances by a direct neurobiological action, and behaviors such as pathological gambling in the form of repeated random rewards. The mechanisms that can lead to addiction to video games are essentially to be found in the way virtual rewards are distributed to players. Indeed, if we make a comparison with gambling, most video games work in the form of rewards (virtual money, virtual equipment, etc.). These rewards are distributed in a rapid manner reminiscent of slot machines, a form of operant conditioning.2 To this are added, as in pathological gambling, other reinforcers of behavior such as social interactions between players (belonging to a group and feeling of obligation to carry out certain tasks in the game) or competition.

Therefore, the probability of developing a problematic use is dependent on the type of gambling practiced. For example, MMORPGs offer a system of quick random rewards, coupled with significant social engagement such as having to be a member of a player guild to progress.3 MMOPRGs are among the games that potentially lead to misuse.

The risk of a problematic engagement also depends on the motivations described by the player. Thus, the fact of wanting to go to the end of the game (Achievement) or that of fleeing the reality of everyday life (Escapism) are elements that can lead to misuse of MMORPGs.4

Definition of problematic use

If the prevalence of pathological gambling and the concrete impact that this disorder has on individuals and their families (debt, psychiatric comorbidities, trouble with the law, etc.) are well described in the literature,5 the even for the misuse of video games. This may seem trivial, but if we want to consider a behavior as problematic, there must necessarily be negative repercussions on the individual or his entourage, and that it is not simply a question of a change societal due to technological development (the impact of radio on health is no longer discussed).

Although this is artificial and sometimes not very representative of reality, for each description of a pathology, it is useful for the understanding of the disorder to isolate a distinct element, the same goes for the practice of video games. Indeed, this is obviously part of a broader practice of screens (internet, television, smartphone, etc.) and ultimately of the individual's way of life.

For video games, characterizing practices is more laborious. When do we cross the symbolic barrier of recreational practice to move towards problematic use? This question represents a real challenge for addictologists.

An attempted answer is to apply the criteria of pathological gambling to video games. In the appendix of the DSM-5,6,7 a proposal of criteria for addiction to video games has been proposed. Although these criteria are criticized by part of the scientific community,8 the fact that they are mentioned in the reference for the diagnosis of psychiatric disorders will, de facto, give them clinical importance. These criteria are 9 in number (Table 1). The diagnosis is positive if five of the nine criteria are met over a period of 12 months.