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Key points
- Internet gaming addiction (IGD) involves gaming-related dependence and impairment.
- IGD can exist with or without concurrent mental health conditions.
- Psychological needs and sociocultural barriers to seeking help can complicate IGD in AAPI youth.
Co-authored by Richard Zhang, M.D., M.A. and Eunice Y. Yuen, M.D., Ph.D.
In 2022, a year after China’s government prohibited youth under age 18 from playing online games more than three hours per week, specifically not exceeding one hour daily on Fridays and weekends, gaming addiction among minors was declared “basically resolved” in China. The nationwide restriction on an occasionally addictive, non-substance-related behavior contrasts starkly with a more medicalized approach common in America. Indeed, it is hard to imagine such legal limitations being accepted in the individualistic U.S. Perhaps increased by COVID-related social isolation, U.S. children between ages 8 and 17 play an average of 1.5 to 2 hours daily of video games on both weekdays and weekends.
Most young video gamers experience no significant consequences from gaming. In fact, age-appropriate computers and console games are often positively adaptive in moderation. Popular series ranging from League of Legends to Dota offer a stress-relieving flow state, entertainment, and socialization when played with real-life friends.
That said, the proportion of young Internet gamers who become clinically addicted is small, although not negligible. In addition to the substance-related addictions, psychiatry’s DSM-5-TR now includes Internet gaming disorder (IGD), a behavioral addiction of excessive gaming that impairs one’s life. A article in the Journal Pediatrics cites an estimated prevalence of 1% and 9%, depending on factors including age and country. Rates increased during the COVID-19 pandemic.
Children and adolescents with few friendships and below-age-expected social skills join virtual gaming communities to meet their basic psychological needs: belonging, competence, and autonomy. They feel respected, socially competent, and less awkward online while engaging with other gamers.
Some consequences of IGD include impairment in academics, social skills development, physical activity, sleep, and mood. Withdrawal symptoms, such as anxiety and irritability, can happen when access to gaming is abruptly stopped.
Controversy exists over excessive gaming as a coping habit for mental health symptoms like depressive emotional pain and ADHD-related understimulation. Yet, even if mood or impulse-control disorders perpetuate heavy gaming, considerable evidence supports a distinct phenomenon of IGD. Obsessive over-gaming, which can protract enough to impair one’s sleep and nutrition, does not always co-occur with other psychiatric diagnoses. Functional MRI imaging of people with IGD further suggests uniquely abnormal baseline activity in brain areas regulating reward-seeking and daydreaming.
If legislative restrictions cannot take effect here, how may American caregivers and clinicians best approach youth gaming addiction? Can we address IGD appropriately across America’s diverse population?
Literature suggests relatively higher rates of behavioral addictions in Asian-American and Pacific Islander (AAPI) populations. Social isolation as an underlying driver of virtual community-seeking is often accentuated in AAPIs, especially immigrants, who face overt racism and microaggressions and can find it challenging to fit into groups in school. It is possible for gaming to evolve into an ingrained habit to escape a lack of autonomy at home, as parents’ cultural expectations of filial obedience and reverence can be hard to confront.
While stigma towards addiction exists in every society, many AAPIs face culturally accentuated stigma and barriers to seeking help. Limited education about addiction as a disease can result in afflicted AAPIs not even recognizing a problem, let alone a treatable one.
For those aware of their addiction, Asian cultural portrayals of addiction as a disgraceful character failure and lack of willpower can create shame and reluctance to risk exposing oneself by seeking help. Some immigrant AAPIs recall severely punitive societal attitudes in their ancestral countries that condone ostracism, incarceration, and even physical beatings of addicts. Consequently, AAPI youth with IGD may confine their problems to themselves or, as often encouraged by therapy-distrusting caregivers, between themselves and their families.
Practical barriers matter too. For example, American addiction programs often incorporate 12-step approaches that are particularly difficult for AAPIs not accustomed to openly sharing emotional difficulties with groups of strangers. More AAPI-sensitive therapists, including some who treat addiction, are joining the American mental health scene but remain in major demand. Furthermore, more AAPI families need awareness that culturally sensitive professionals who treat addiction conditions like IGD exist.
The American Psychiatric Association emphasizes that IGD is a new classification that continues to evolve with more research findings. This does not negate that gaming addiction exists in those with dependence and impairment and can be treated. Psychiatrists and pediatricians, especially when coordinated, can check for non-IGD mental health conditions in youth with excessive gaming, which can arise either from IGD or as coping for other disorders.
Forms of therapy such as cognitive behavioral therapy and multidimensional family therapy are suggested to alleviate youth IGD; studies on medications are preliminary but sometimes promising. Youth IGD patients and caregivers can try to frame addiction as a disease and prioritize mutual child-parent validation, support, and open communication about observations and feelings towards symptoms. For American youth of AAPI and other backgrounds facing IGD, instead of legislative enforcement, solutions require a flexible yet “whole package” approach of professional help, lifestyle changes, and healthy home dynamics.
Richard Zhang, M.D., M.A., is a psychiatry resident doctor at the University of Connecticut. Concurrently with residency, he serves as an affiliated faculty at the UConn Asian and Asian American Studies Institute, and as the 2023-2024 Chair of the American Psychiatric Association's Assembly Committee of Area Resident-Fellow Members.
