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I'm sure most of you love to play Call Of Duty during the school holiday. Playing games can provide numerous benefits which include improves concentration, enhance problem-solving skills and improves overall brain's performance. However, this particular activity could become a problem if it started to interfere with an individual's life. According to Bartle, gamers can be categorized into four groups based on their playing preferences in the game:

• The achievers: This is someone who plays a game for the sake of getting validation and approval from the virtual community. Game features such as "level up" or obtaining new power are important for them as they usually play the game either to finish or to achieve the highest rank in the virtual open world. They were competitive and also easily frustrated if any other player were to surpass them. Their action was usually goal-directed.

• The explorer: Nothing makes them excited other than enjoying the game's infrastructure and discovering new storylines included with the game. This kind of player is quite adventurous. They are not quite concerned with their position or level of acceptance in the virtual society.

• The socializer: This player plays for the sake of socializing in the gaming community. They are usually the leader of a guild, someone who gathers a population of virtual character to form a community and love to chat for hours in the game.

• The trolls: This is the lowest among the other class of players. They are not interested in helping to build a community or anything, but rather enjoy bullying and cheating other players. Scammers, beggars and spammers are grouped in this category.

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In 2006, Yee tried to make a new approach to classify individual roles in the gaming community and finding out their motives for playing. After carrying out a meticulous 40-item questionnaires survey, she classifies these motivations into three broad categories based on their gaming focus:

First category

• Gaming advancement: Love to level up character
• Mechanics: Optimizes game to face a more difficult challenge
• Challenge: Love to dominate other players and earn reputations for their talents/skills.

Second category

• Social component: Love to chat, socialize and create guild to form a community

Third category

• Discovery: Love to search for new in-game items
• Escapism: Try to forget all of the problems related to the real world
• Role-playing: Creating new persona based on player's imagination

There are two indicators which are used to identify problems in gaming which commonly found among gambling-addicted individuals which are positive urgency and "immersion".

Positive urgency is the tendency to act rashly while in a positive mood. which make it even difficult for a gamer to avoid online gaming

Immersion in the realms of virtual reality, when faced with negative affect to avoid real-life problems, is again one of the principal motivations for gamers.

Internet addiction disorder versus internet gaming disorder

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Even though both of them appear similar, they are a different entity. According to Griffith and Pontes, there are many studies conducted in the past couple of years which utilized the internet addiction-related or other nonvalidated questionnaires to measure the severity of online gaming addiction. This is why, in the Diagnostic and Statistical Manual of Mental Disorder 5th Edition (DSM-5), internet gaming disorder was classified together with the internet addiction disorder. In 2014, a study carried out by Keraly et al found that the demographic data and pattern of behaviours between these two group of disorders was quite different. For example:

• In internet addiction disorder, the individual affected is usually male who invested lots of time online related activities such as chatting, social networking and video streaming. In internet gaming disorder, the activity was solely gaming so theoretically, both of them have conceptually different behaviours.

For the past couple of years, there had been some discussion and debates whether or not to separate internet gaming disorder as a different entity to internet addiction disorder. When DSM-5 was published in 2013, internet gaming disorder was given a specific definition:

Persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12 months period

The criteria include:

• Continued excessive utilization despite psychosocial problems.
• Deceiving
• Escapism
• Functional impairment
• Loss of interest in other activity
• Tolerance
• Withdrawal
• Unsuccessful attempts to control said behaviour

Prevalence and risk factor for internet gaming addiction

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In 2014, a review journal published by Kuss et al found that Asian countries have a higher prevalence of internet gaming disorder compared to the Western countries. In South Korea alone, 50% of the adolescents were found to be addicted to gaming and up to 24% of people with internet addiction disorder need to be admitted to the hospital. It is unusual, isn't it? Can you imagine what its like to be admitted just because you're addicted to socializing on Facebook rather than the real world? However, due to a different kind of behavioural pattern between these two addictions, we cannot judge the data obtained for internet addiction disorder to measure the severity of internet gaming disorder. In 2013, a study which is conducted by Wang et al in Hong Kong shows nearly 16% of students fulfilled the criteria for diagnosing gaming addiction. This rate was prevalence among boys (23%) compared to girls (9%).

The severity of gaming addiction can be affected by a few risk factors:

• Advancing age
• Low self-esteem
• Poor satisfaction with daily life
• Pathological family relationship
• Divorced parents
• Peers involved in gaming

In 2015, Donati et al conducted a study to investigate the relationship between the genre of the game and severity of gaming addiction. Most of the subject vouched for action, casual and sports genre while real-time strategy was the less chosen. This factor affects the time spent on gaming which could indicate a potential addicting behaviour among the players. They also found that the duration spent on gaming increases significantly if there is an online play option.

Associated comorbidities and behavioural issues with internet gaming addiction

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Prolonged pathological gaming behaviour can lead to multiple physical's and mental's negative consequences which are usually worsening with time. There is numerous literature which documented some kind of psychopathologies which can be associated with chronically addicted gamers. In a study conducted in 2011 which compared characteristic and behaviour of addicted gamers and non-addicted gamers, they found that people who are addicted were less agreeable and emotionally unstable. Their feeling of anger, envy, anxiety and guilt were intensified compared to the control group. They were found to be mostly sleep-deprived and more relatable to escapism, self-comparison with internalized persona and associated depressive disorder.

A chronically addicted gamer also is more likely to be involved in substance abuse disorder which can lead to a wider range of problems. They are 3 times more likely to be diagnosed with the Attention Deficits Hyperactive disorder (ADHD) associated with mood disorders. In 2014, Jalink et al published a review journal which reported a wide range of physical injuries caused by handheld gaming devices such as Game Boy, Game Cube, Wii etc. This includes:

• Tendinitis of the wrist and thumb
• Auditory hallucinations
• Seizure due to rapid change in on-screen patterns
• Enuresis
• Musculoskeletal problems and trauma

Prevention and treatment

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There are many preventive strategies that can be applied to individuals with internet gaming addiction. In 2009, Griffiths and Meredith published a guideline which can be used for treatment purpose among individual with internet gaming disorder.

• Find out about the content of the video game being played. If it has some objectionable contents, a discussion and some rules need to be set.
• Both parents and professionals should aim at choosing games which is fun and constructive
• Make the person understand the difference between make-believe and reality
• Solitary game playing should be discouraged
• Recommendations on the possible risks outlined by video game manufacturers should be followed
• Ensure that plenty of other activities are available to be pursued by the addicted individual in their free time besides playing video games

Online support groups

There are a lot of online support forums that sprung up for the past couple of years which conducted a 12-step internet-based treatment approach to overcome internet gaming addiction:

• Honesty and acceptance
• Action and courage
• Integrity
• Hope
• Faith
• Willingness
• Humility
• Love
• Justice
• Perseverance
• Spirituality
• Service

References

• Bartle R. Designing Virtual Worlds. New Riders: New Riders Publishing Inc; 2004. p. 741.
• Yee N. Motivations for play in online games. Cyberpsychol Behav. 2006;9:772–5.
• Kuss DJ. Internet gaming addiction: Current perspectives. Psychol Res Behav Manag. 2013;6:125–37.
• Billieux J, Chanal J, Khazaal Y, Rochat L, Gay P, Zullino D, et al. Psychological predictors of problematic involvement in massively multiplayer online role-playing games: Illustration in a sample of male cybercafé players. Psychopathology. 2011;44:165–71.
• Cyders MA, Smith GT. Emotion-based dispositions to rash action: Positive and negative urgency. Psychol Bull. 2008;134:807–28.
• Griffiths MD. Internet addiction disorder and internet gaming disorder are not the same. J Addict Res Ther. 2014. [Last cited on 2016 Feb 04]. p. 5. Available from: http://www.omicsonline.org/addiction-research-therapy-abstract.php?abstract_id = 35644 .
• Király O, Griffiths MD, Urbán R, Farkas J, Kökönyei G, Elekes Z, et al. Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychol Behav Soc Netw. 2014;17:749–54.
• Hur MH. Demographic, habitual, and socioeconomic determinants of Internet addiction disorder: An empirical study of Korean teenagers. Cyberpsychol Behav. 2006;9:514–25.
• Gentile D. Pathological video-game use among youth ages 8 to 18: A national study. Psychol Sci. 2009;20:594–602.
• Naskar, S., Victor, R., Nath, K., & Sengupta, C. (2016). “One level more:” A narrative review on internet gaming disorder. Industrial Psychiatry Journal, 25(2), 145–154.