Unhealthy passion for gaming amongst adolescents requires clinical intervention by medical professionals

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Research by Oxford University, carried out in partnership with Cardiff University, and published today in Clinical Psychological Science, has found little evidence to suggest an unhealthy passion for gaming amongst adolescents, often referred to as “gaming addiction,” requires clinical intervention by medical professionals.

Based on data from over 1,000 adolescents and their caregivers, the study suggests those engaged in dysfunctional gaming are likely to have underlying frustrations and wider psychosocial functioning issues outside of games.

These issues are likely to lead them to seek contentment by gaming, rather than being negatively impacted by gaming itself.

Professor Andrew Przybylski, Director of Research at the Oxford Internet Institute and co-author of the study, said

“The World Health Organisation and the American Psychiatric Association have called on researchers to investigate the clinical relevance of dysregulated video-gaming among adolescents, as previous studies have failed to examine the wider context of what is going on in these young peoples’ lives.

This is something we seek to address with our new study. For the first time we apply motivational theory and open science principles to investigate if psychological need satisfactions and frustrations in adolescents’ daily lives are linked to dysregulated – or obsessive – gaming engagement.

“Our findings provided no evidence suggesting an unhealthy relationship with gaming accounts for substantial emotional, peer and behavioral problems.

Instead, variations in gaming experience are much more likely to be linked to whether adolescents’ basic psychological needs for competence, autonomy, and social belonging are being met and if they are already experiencing wider functioning issues.

In light of our findings we do not believe sufficient evidence exists to warrant thinking about gaming as a clinical disorder in its own right.”

The study tested hypotheses considering the extent to which adolescents exhibiting dysregulated gaming reliably links to whether their basic psychological needs were being met.

Adolescents completed questionnaires about their gaming behavior, including providing details of how long they spent playing video games, with whom they played and if they used the internet to play games. In addition their caregivers rated their child’s emotional and social health.

Key findings include:

  • Most adolescents played at least one internet-based game daily.
  • Less than half of daily online gamers reported symptoms of obsessive gaming.
  • Daily players were highly engaged, devoting an average of three hours a day to games.
  • There was little evidence that obsessive gaming significantly impacted adolescent outcomes.

Dr. Netta Weinstein, Senior Lecturer, School of Psychology, University of Cardiff and co-author of the report, said: “We urge healthcare professionals to look more closely at the underlying factors such as psychological satisfactions and everyday frustrations to understand why a minority of players feel like they must engage in gaming in an obsessive way.”

Professor Przybylski added: “Whilst the growing popularity of gaming has incited concerns from health care and mental health professions, our research provides no compelling evidence that games, on their own, are to blame for problems facing players. We need better data and the cooperation of video gaming companies if we are to get to the bottom of all this.”

The full study, “Investigating the Motivational and Psychosocial Dynamics of Dysregulated Gaming: Evidence from a Preregistered Cohort Study’ by Professor Andrew Przybylski and Dr. Netta Weinstein, is published open access in Clinical Psychological Science.


Over the past two decades, the number of female video game players has increased, and females today make up half of the gaming population according to both the Entertainment Software Association (ESA) (1) and the Interactive Software Federation of Europe (ISFE) (2).

Simultaneously, research on addictive internet use has proliferated, and gaming disorder was recently recognized as a new mental health disorder (and a behavioral addiction) by the World Health Organization (3).

Thus, gaming addiction is now officially a new psychopathology that has emerged as a consequence of the development and increasing popularity of video games and online technologies during the 21st century.

Despite the growing female gaming population, almost all research on gaming addiction is focused on male gamers.

Currently, there is no agreement on the prevalence of gaming addiction due to its conceptualization and methodological problems within the research that has been conducted to date.

This is because most research

i) comprises surveys using non-representative samples (i.e., instead of using randomized samples, or other methodological approaches, such as classic experiments or mixed methods research);

ii) uses different scales to assess problematic gaming [e.g., Problem Video Game Playing Questionnaire (4) for offline and online video gaming, Internet Gaming Disorder Scale–Short-Form (5)];

iii) uses scales and screens based on different addiction criteria (e.g., substance use disorder criteria, gambling disorder criteria);

iv) uses different cutoff scores even when using the same instrument;

v) utilizes different conceptualizations of gaming [e.g., problematic gaming, addictive gaming, internet gaming disorder (IGD), online gaming disorder, offline gaming disorder];

vi) assesses gaming without taking into account the various technologies and devices (e.g., computers, consoles, smartphones, and tablets); and vii) does not tend to take into account the different game genres played [e.g., massively multiplayer online role-playing games (MMORPGs), multiplayer online battle arena (MOBA) games, etc.].

For these reasons, the estimated prevalence rates of disordered gaming have been reported to range from 0.2% up to 34% (6), which is highly variable for a disorder.

However, among samples using nationally representative data, the range is much smaller (up to 9% at most) (6).

Higher prevalence rates are reported in Asian countries, especially in young adult males (7).

However, very little attention has been paid to the societal and cultural parameters associated with gaming, even in cross-cultural studies.

These tend to have a robust psychometric approach that usually guarantees measurement invariance across languages (89) and focus on individual factors (1011).

However, these recent studies suggest an integrative biocultural approach (i.e., to distinguish universal as opposed to culturally contingent dimensions of human suffering) as well as addressing socio-cultural factors and how these impact on mental health (in general) and problem gaming as a potential form of behavioral addiction (more specifically).

During the past decade, a few empirical studies have specifically researched female gaming (1214).

Through interviews and online diaries, Lewis and Griffiths (12), as well as McLean and Griffiths (15), highlighted that women usually play casual games typically for shorter periods compared with men.

They take on their own female roles as gamers and have their own

i) gaming experience and habits,

ii) game motivations and choices,

iii) technology preferences, and

iv) gamer identity.

In summary, this research has found that female casual gamers report

i) peripheral knowledge from gaming [i.e., technical knowledge, games knowledge in First-Person Shooter (FPS) and MMORPGs];

ii) gaming as a domestic life priority (i.e., gaming as an activity influenced by shared vs. non-shared leisure pursuit, unsympathetic partner, facilitating social behavior; e.g., Wii Walk It Out);

iii) gaming as a personal preoccupation (e.g., as routine in daily life, to satisfy an emotional need, for competition and/or self-challenge, as an enjoyable waste of time, or as a hobby); and

iv) gaming and technology as gendered (i.e., concerns about gendered stereotypes) because female gamers characterize themselves as “tech-savvy” (which goes alongside social perceptions as “geeky guys” because gamer identity appears to be more associated with masculinity).

However, it has also been found that women feel comfortable making technology purchases and consider age as a more important factor than gender, which appears to negatively affect older women who do not grow up with technologies and online video games. Finally, female identity is sometimes viewed as vulnerable and may underlie why some female gamers utilize male avatars in-game.

However, from a neuroimaging perspective, Wang and colleagues (14) recently found that females appear to be more vulnerable to online gaming addiction relative to males. The study tried to get a better understanding of sex differences relating to biological mechanisms underlying IGD, a proposed mental health disorder included in the final section of the latest (fifth) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (16).

They used the structural magnetic resonance imaging technique and detected a group-by-sex interaction. More specifically, they found that male and female IGD participants had increased and reduced cortical thickness, respectively, alongside their right posterior cingulate cortex (PCC) compared to same-sex recreational game players. Contrarily, male and female IGD participants reduced and increased cortical thickness, respectively, in their right PCC. Moreover, only females had negative correlations between cortical thickness and their self-reported cravings and IGD scores.

These findings suggest that males and females are differently affected by IGD and that women are more vulnerable than men based on the effects created by IGD in the brain regions examined.

More recent quantitative studies analyzing IGD (1718) have found that the prevalence of disordered gaming appears to be more balanced than previous studies.

For instance, a recent study (17) found differences between genders when comparing specific problematic internet uses, where the potential at-risk problem online gamers comprised 10.8% of the total sample (i.e., 5.3% males and 5.5% females).

Moreover, how gaming preference affects IGD scores across genders has been also observed (18), where IGD was predicted by several variables with gender differences. This included time spent online, gaming motives, and depressive symptoms.

For female gamers, IGD predictors included higher time spent online, higher scores on specific gaming motives (i.e., escape and competition), together with significant depressive symptoms, compared with male gamers [e.g., whose IGD predictors were two types of motives to play online video games (i.e., escape and coping), together with higher depressive symptoms than females].

Another gender issue in IGD concerns gaming preference across genders. For example, the respective game genre that individuals play has a different effect on IGD score depending upon the player’s gender, although results are contradictory (e.g., men appear to prefer MMORPGs, while women appear to prefer casual video games) (18).

For men, coping is a predictor of IGD, while for women, competition is a predictor, whereas escapism is a predictor of IGD in both genders.

However, in a recent quantitative study concerning female gaming, women who played video games also reported spending more time on role-playing games, MMORPGs, FPS games, simulation games, action-adventure games, casual games, and MOBA games. Moreover, achievement and social motivations were predictors of IGD and daily time spent online (19).

Thus, the preferred game genre may explain differences between genders in terms of time spent gaming (e.g., especially FPS games, MMORPGs, and MOBA games) and IGD scores (e.g., especially MMOPRGs and MOBA games), at least among female gamers (19).

Clinicians treating gaming addiction have reported that this mental disorder may go unnoticed in females (20) and that women being treated for this problem appear to show differences in the experience of other psychopathologies (including IGD and other addictions) compared with men (21).

Nevertheless, problematic and potentially pathological gaming in women has rarely been addressed in either theoretical work or empirical research.

With respect to the scarce literature on female gaming and female gaming culture (22), women are arguably situated outside of video game culture (i.e., they are not part of traditional masculine gaming culture) (1819), which results in a low gamer identity profile (and is a reason why women may choose a male avatar while gaming or is more competitive than male gamers), and needs to take into account about how and why female gaming can become stigmatized.

Women are often discriminated against by male players, which also discourages women from labeling themselves as gamers (13).

A number of comprehensive narrative reviews have been undertaken regarding the phenomenon of female gaming relating to gaming culture. According to male gender stereotypes, women are not considered as “true” or “hard-core” gamers (where video game skill is viewed as the main defining feature of a “gamer,” e.g., playing more complex and competitive video games on dedicated consoles, identifying with the gaming community, and sometimes engaging in competitive electronic sports where gamers can earn money in international tournaments), mainly because they appear to play more casually and less skillfully compared to their male counterparts (23).

However, this depends on how “gamer” is defined and the fact that most professional gamers are male. Furthermore, female players who achieve a high level of skill and competence are invisible and/or actively marginalized and may be problematic in terms of the conceptualization of “female gamer.”

Moreover, the association between representation of women within video games and their well-being has been recently studied (24).

Findings showed female gamers report self-objectification and consequently perceive low levels of self-efficacy, which was corroborated by both genders (e.g., female characters are usually subordinate to the male hero, in addition to being objectified and hypersexualized).

Nevertheless, solutions to some of the effects of stereotype threat on females’ gaming performance have been demonstrated via experiments.

Kaye and Pennington (25) examined the impact of stereotype threat on female online gamers’ performance (i.e., situations in which individuals’ performance may be hindered by stereotype-salient cues), and whether manipulating the availability of multiple social identities (i.e., personal self and the self as a product of valued social groups) is established effectively for eliminating these performance decrements.

Findings showed that stereotype-threatened females underperformed on the gaming task relative to males in the control condition (e.g., prejudice in online video games), and the intervention of multiple social identities appeared to protect females’ gaming performance from stereotype threat (e.g., via more supportive gaming communities through inter-group cooperative tasks).

Thus, two types of harms appear to be associated with female gaming at present:

i) the personal harm of potential gaming addiction at an individual and psychopathological level, and

ii) the societal harm of stigmatizing female gaming at a community and psychosocial level.

To date, few studies have focused on the second type of harm studies, and even fewer have examined gaming behaviors based on individual gamers’ perceptions and potential risk of psychopathology, such as gaming addiction [e.g., IGD (1719) or Gaming Disorder (5)].

Moreover, almost all studies reported have focused on negative consequences associated with female gaming without assessing female gaming behavior from both positive and negative perspectives at individual and community levels.

Consequently, there is a gap in knowledge regarding female gaming from a gender perspective, including its nature, benefits, and potential risks to individual and community health.

In order to overcome the limitations in female gaming research, the aim of this narrative literature review is to provide a comprehensive overview of studies assessing female gaming or the position of women within gaming culture. The present paper includes studies from both an individual perspective and a cultural perspective in order to obtain a more inclusive and contemporary view of gaming behavior in females.

Results

Forty-nine studies were identified that met the inclusion criteria for this review (see Figure 1; see Appendix A in the Supplementary Material). As this study was the first of this nature concerning female gaming, the included studies represented research using various methodologies, such as clinical trials, experimental studies, and case studies, as well as other methodologies. Four main types of research were identified: i) the benefits of female gaming; ii) why women might play video games less than men; iii) perceptions and realities of female characters within video games; and iv) women’s position in gaming culture. The results section briefly outlines each of these. A few studies had material which could be included in more than one category.

The Benefits of Female Gaming [n = 11]

Within the included studies, several considered how women engaging with video games might have a beneficial outcome. These comprised research examining clinical or environmental interventions (3540), investigating cognitive and social learning, as well as strategies developed through game play (36374145). Studies that investigated the utility of video games to enrich an aspect of the participants’ life were proportionally more recent than those which considered other features of female gaming (3540). Clinical interventions considered the physical (363739) and mental benefits (353738) which could be offered to women who interact with video games. All of these studies saw improvements in their participants’ abilities or health. However, they had relatively small sample sizes (ranging from two seniors (3740) to 23 women (37). The majority of studies also recruited from only one website (353840).

Despite these limitations, video games were shown to have physical benefits, such as encouraging exercise in adults with lower mobility due to age and illnesses (373840) and relieving pain symptoms in participants with fibromyalgia syndrome by offering cognitive distraction (38). Female gaming was also shown to improve mental well-being because video games were demonstrated to be acceptable psychotherapeutic tools to assist mental health recovery in adolescents (35). Gaming positively influenced executive functioning ability in women with urinary incontinence (37) and attention in elderly individuals (40). Two studies considered how gaming environments might be utilized as a teaching tool within undergraduate student populations (36). In both studies, it was observed that learners with less gaming experience showed lower levels of presence within the environment than others and that women were just as likely to succeed with this type of educational intervention as men (3639). However, DeNoyelles and colleagues (36) concluded that college-age women were less likely to be gamers. Therefore, they suggested that female non-gamers might struggle slightly more due to less gaming experience and suggested standardized support according to gender.

Even at an early age, it has been demonstrated that girls have similar abilities to gain strategy and performance skills by playing video games compared to boys (41). This was shown in 104 children (second to fifth-grade) where frequency of gaming was viewed as a better predictor of gaming performance and strategy than gender (41). This was reinforced by Olson and colleagues (45) who considered the main differences between video game play of males and females to be the amount of time spent playing and the types of video games. In a sample of 1,254 children taken from two schools’ seventh and eighth grade classes, it was shown that gaming was very common with 93.6% of children playing video games over the past 6 months but that boys were much more likely to play over 15 h a week in comparison to girls (45).

In a cross-country study of 145 young girls (M = 11.3 years) who played video games online, it was shown that prosocial gaming exposure to typical online video games (e.g., MMORPGs) had a strong relationship with perspective taking and sympathy, suggesting less severe violence acceptance (43). Within in-person co-playing, a subsample of girls demonstrated heightened prosocial behavior and stronger emotional connection when engaging with their parents (44). Again, this is evidence that video game playing has a positive impact on how girls develop their cognitive abilities, including social interaction. Alternatively, Olson and colleagues (45) demonstrated that more boys played video games than girls and that gaming could be utilized as a male anger management strategy. This could be reflective of how adolescents are primed to cope with emotional responses.

It has also been found that adult female gamers need less input when evoking response reactions than female non-gamers and have a greater neural plasticity which enhances this ability due to the familiarity of movements which are needed in gaming (42). This was verified in two studies by Gorbet and Sergio (42), in which they showed that playing video games has beneficial consequences on visuomotor performance but that these brain patterns are different from previous studies observing male responses, which may indicate different ways in which male and female brains react to problem solving within video games. Nonetheless, video games have a positive impact on muscle movements and response times to stimuli, as well as enhancing brain plasticity (42).


Journal information: Clinical Psychological Science
Provided by University of Oxford

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