When most people think about gaming, they conjure up images of boys and young men, wasting hours in front of a computer playing the latest violent battles either from a purchased game or online with other gamers. In Sweden last year, the Youth Care Foundation published a report which dubbed World of Warcraft “the cocaine of the computer games world” and were bombarded with calls from around the world from people who thought they or someone they knew might be addicted. “Generally we’re talking about boys and young men who end up playing games so much that other aspects of their lives like family, work, school, relationships all fall by the wayside,” they center is quoted as saying.
But it turns out that boys and young men are not the only ones hooked on gaming. In fact, a new study conducted in January by PopCap — creator of popular social games such as Bejeweled and Insaniquarium – found that the average player of online social games is a 43 year old woman.  Most of these social gamers are working full time, and many of them are married with children. The stated appeal of this activity is fun and excitement (53%), stress relief (45%) competitive spirit (45%), and some of the gamers acknowledged that other activities, such as reading, watching TV, doing hobbies and exercising had declined as a result, as they are typically gaming several times per week.

The economic impact of this activity has been tremendous: a new report released Thursday estimates Zynga Inc., the San Francisco company that makes popular social media games like FarmVille, Mafia Wars and FishVille, is worth between $2.8 billion and $3.3 billion. Zynga has more than 230 million monthly users on Facebook alone.

However, while the economic impact may not be in question, the question does remain what the social, emotional, and psychological impact may be on so many women choosing to spend their time social gaming instead of doing other things.

Samantha Smithstein, Psy.D.

Recently, PBS’ investigative journal series Frontline aired a program called “digital_nation: life on the virtual frontier” to explore the effect of electronic media on modern life.  One of the main foci of this program was youth, and how computers, gaming, and the internet are affecting young people.

Contrary to popular belief, an “addiction” to electronic media of any kind has yet to be classified as a diagnosis or mental health problem in the United States. Frontline reported that in South Korea gaming addiction is understood as a mental disorder and the government has set up treatment programs for kids who are considered to be exhibiting problematic behaviors and symptoms, such as falling grades, inability to stop playing games on the computer for hours, and eye strain.

In December 2009, a study published in Injury Prevention reported that adolescents who are addicted to the internet are more than twice as likely to have injured themselves, including hitting themselves, pulling their own hair, or pinching or burning themselves.  Even after researchers accounted for other variables associated with self-harm, such as depression or stressful life events, the link was found to be significant.

No causal relationship can be established.  It is quite possible that kids who have psychological issues that may cause them to harm themselves are more susceptible to becoming addicted to the internet and vice-versa.  However, either way the link remains significant and troubling.

Samantha Smithstein, Psy.D.

In a previous article, “process addictions” such as addiction to sex, stealing, food, etc. were explored as legitimate disorders and inclusion was called for in the diagnostic manual. One possibility explored in that article was that it be included in the category of “Substance-Related Disorders,” since the experiences of people who feel compelled to repeat these behaviors are often highly similar to the description of the experiences of people dependent on substances (the diagnostic criteria).

There is, however, another category of diagnoses under which process addictions could potentially be included: that of Anxiety Disorders such as Obsessive-Compulsive Disorder. A person with Obsessive-Compulsive Disorder has recurrent and persistent disturbing, intrusive and inappropriate thoughts or impulses that they cannot ignore or suppress. This person then feels driven to perform a behavior in order to reduce the thoughts or impulses. The behavior is either not realistically connected to the thought or is excessive.

Most traditionally, obsessions are related to fears (getting ill) and compulsions are related to simple, common acts such as hand washing, ordering, checking, counting, or repeating words silently. The person may even rationally know that the behavior won’t make the fear/thought go away, but they still feel compelled to action, over and over again.

However, it is possible that some people attempt to quash the intrusive thoughts or fears  by behaviors such as shopping, eating, or masturbating, and that the person feels driven to this behavior in spite of knowing that it will not, ultimately, solve their problems. Often people describe an experience of feeling anxious, alone, or generally “uncomfortable.” They seek out a behavior in an effort to feel better, even as they are aware that when they are done, they will feel even worse.  Sometimes they find themselves repeating the behavior over and over, such as masturbating for hours even after it ceases to feel pleasurable.

This way of thinking about compulsive or “addictive” behaviors is a less common way of conceptualizing it, but for some, it may be exactly what ails them.  And, as in the case of substance dependence, inclusion in the new diagnostic manual could get them the help (and medical coverage) they need.

Samantha Smithstein, Psy.D.

The diagnostic manual for mental disorders (DSM-IV-TR) doesn’t actually have the word “addiction” in it. Nor does it have a category related to addictions. Instead, it has a category called “Substance-Related Disorders” and lists Dependence, Abuse, Intoxication, and Withdrawal as the four subsets.

This means that when people speak of being “addicted” to things such as sex, gambling, food, stealing, electronic media and gaming, shopping, etc. they are speaking about an experience that does not exist in the realm of diagnoses. This is part of why there is a paucity of good (and necessary) research done with these kinds of “process addictions” (versus substance). This is also why there is no insurance coverage for treatment, and the treatment available has been pieced together by therapists who have co-opted concepts from other areas of psychology, like substance abuse. To talk about addiction is to be in the realm of “pop psychology” versus legitimate psychology.

Part of the rationale for this absence is that the manual is based on psychiatry, and therefore based on a medical model of looking at disorders. In other words, substance dependence (or, in layperson’s terms, substance addiction) is based in part on a physiological dependence to the substance.

But this does not acknowledge that a process addiction can also have a physiological dependence – many people who are addicted to these behaviors report feeling a craving, a high, and then a crash (and withdrawal) afterward. Additionally, they often report a need to raise the stakes to get the same level of high, similar to an increased tolerance of a substance. People report that it interferes with their relationships, they feel compelled to keep doing it in spite of terrible consequences, and they can’t stop. These are all listed as symptoms of Dependence.

There is a lot of discussion right now about the next revision of the manual.  It may be time to re-think this category in the diagnostic manual so that people who feel compelled to repeat behaviors at great expense to their lives can get the treatment they so desperately need.

Samantha Smithstein, Psy.D.

People always speak disparagingly about those who they perceive to be in denial.  “She’s in denial,” they say in disapproving tones, “He needs to get real.”

The truth, however, is that we all use denial regularly.  Denial is a defense mechanism – a way of avoiding realities or facts that make us uncomfortable when the reality is too painful or shameful, embarrassing or threatening.  In other words, it is a way we all defend ourselves from the pain of reality.  Denial can also to keep us from getting in trouble; to give it up can feel very dangerous and frightening if it means facing consequences.

“Getting real,” then, represents a tug of war of sorts: there are powerful reasons for honesty and powerful reasons for denial.  Sometimes, denial can be helpful for coping and should not be given up.  For example, when someone we love goes in for a dangerous surgical procedure, denial can help us get through that time with hope and calm and survive the hours.  However, denial can also be dangerous and unhealthy, as it can prevent us from getting the help we need.

Regardless of whether it is important or unhealthy, however, it is something we all can relate to and struggle with.  And it is something worth getting more conscious about, because the more we can see it, the more we are free to make choices about it.

Samantha Smithstein, Psy.D.