Vancouver researchers urgently call for more studies to be conducted on masculinity and video-game addiction

As online gaming has developed into a highly lucrative market with the likes of World of Warcraft or League of Legends, heightened concerns about the growth of internet gaming disorder (IGD) have arisen as well.

With internet gaming experiencing massive growth in Asia, generating an estimated profit of $12 billion in China alone in 2013, addictive gaming behaviour has been a serious health concern in China, Taiwan, and Korea, and has primarily been studied in Asia.

In 2013, the American Psychiatric Association (APA) listed IGD as a condition that requires further research before officially recognizing it as a mental disorder. IGD includes symptoms similar to substance use disorder, which includes evidence of changes in brain activity and structures.

However, the World Health Organization announced that it has added gaming disorder to the addiction section of the 11th edition of the International Classification of Diseases (ICD-11) released today (June 18). ICD-11 defines gaming disorder as "a pattern of gaming behavior...characterized by impaired control over gaming, increasing priority given to gaming over other activities...and continuation or escalation of gaming despite the occurrence of negative consequences".

The ICD-11 stipulates that a diagnosis of gaming disorder requires a behaviour pattern "of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months".

Meanwhile, a UBC School of Nursing study published in the American Journal of Men's Health in April was led by UBC Master's student Kevin H. Chen and highlighted during Canaidan Men's Health Week (June 11 to 17). The research paper conducted an in-depth review of existing studies about IGD, with a focus on 13 of them. More specifically, the researchers sought to examine what relationship might exist between masculinity and gaming addiction.

While males have been found to devote more time and effort to gaming than females, the study points out the industry's systemic gender bias: most games are designed by males for males, and marketing is primarily geared towards male consumers as well.

Yet despite this fact, the UBC researchers point out that what is lacking in almost all of the studies thus far is an exploration and examination of the connection between masculinity and IGD. This neglected area of research creates challenges in diagnosis and treatment of the addiction, as more difficulties already exist in getting men to access health services than women.

In the same way that some individuals resort to excessive alcohol consumption or drug use to deal with emotional distress or mental illness, gaming may be a new form of self-medication to address mental-health issues rather than seeking help or discussing emotions. In addition, the study's senior author and UBC Men's Health Research founder John Oliffe points out that an increase in mental illness among younger male generations has been linked to social isolation and masculine practices of stoicism and self-reliance. Moreover, one study suggests that the increased interest among younger generations in maintaining extended leisure time may result in using gaming to delay the onset of adulthood.

The study explain that IGD can appear similar to the symptoms of mental illnesses, and the relationship between IGD and mental illness—whether it is casual or compounds pre-existing conditions—can be unclear.

The UBC analysis cites three common motivations among males that contributed to addictive gaming behaviour: achievement, sociability, and immersion.

Achievement referred to advancement in a game through leveling up, acquiring status and power, and increasing abilities to face off against opponents. Achievement was noted as a much stronger influential factor for male than female players. Reputation and admiration from other gamers for skilled game performance also further encouraged game play.

Interactions between gamers offers opportunities for new friendships and work in teams, which can appeal to those who are experiencing loneliness or have few to no friends in real life. The researchers point out that this means for social connections has been linked to mental illness, including anxiety and depression.

The need to escape from the real world—including the avoidance of negative thoughts, moods, or feelings of failure—was cited as the strongest association with addictive behaviour.

A list of physical, psychological, and social consequences of gaming include eye strain, potential permanent visual impairment (particularly among teenagers), muscle tension and postural problems (due to prolonged sitting), reduced or strained real-life relationships, lack of self-care, sleep deprivation, poor nutrition, lowered academic and work performance, low self-esteem, loneliness, increased aggression and hostility, lowered recall for verbal word usage, and cognitive distortions, including irrational beliefs or inaccurate perceptions about one's self.

Several extreme cases leading to death (often due to cardiac arrest during binge-playing over several days), murder, and even the neglect of infants or toddlers (some resulting in fatalities) have been reported in Hong Kong, China, Taiwan, South Korea, Vietnam, and the U.S.

Although there isn't consensus on a definition of IGD, the APA has proposed the following criteria for IGD, with five or more of the nine criteria as necessary for an IGD diagnosis:

• preoccupation: obsession with internet gaming to the point of distraction from daily functions
• withdrawal: unpleasant symptoms experienced after stopping play, such as sadness, irritability, anger, anxiety, lack of concentration
• tolerance: the need to play for longer periods or to acquire new games or equipment to achieve a sense of satisfaction
• unsuccessful attempts at self-control: the inability to control gaming behaviour under control despite the desire to do so
• loss of interests: decreased involvement in activities, such as sports, that a gamer previously enjoyed
• continued usage despite problems: continuing play despite awareness of problems such as lowered performance at school or work or even loss of employment
• deception: lying about gaming time to avoid disapproval from friends or relatives
• escape from negative moods: a maladaptive coping strategy to use game play to escape from feeling things such as anxiety, depression, or helplessness
• functional impairment: impairment of daily functions and relationships, education, or career that can also impact the well-being of others close to them, such as spouses

The researchers are urgently calling for further research to validate the diagnostic criteria before it can be developed and adopted in order to address what they are identifying as a "significant emergent men's health issue". They also note that more cross-cultural studies need to be conducted, as most of the studies were from Asia. Another suggested area of research is how male gamers perceive the impact of their gaming behaviour on others.