________________________________________________________________________ Behavioral Addictions
Addicted Internet gamers show patterns of physiologic arousal deficits that differ by game genre. In addicted MMORPG gam- ers, cardiovascular activity (as measured by heart rate, blood pressure, and skin conductance) significantly decreases during gaming compared with pre-game baseline but significantly rose after gaming. Addicted FPS gamers had significant increases in blood pressure during gaming, decreasing significantly post-game. Non-addicted MMORPG and FPS gamers showed increased blood pressure during and after gaming [223]. ASSESSMENT AND DIAGNOSIS Clinical assessment of patients with suspected Internet gam- ing disorder is necessary to explore the clinical severity and negative biopsychosocial impact via inquiry ( Table 3 ). The DSM-5 Task Force asked the Substance-Related Disorders Work Group to consider several potential behavioral addic- tions for inclusion in the DSM-5. The Work Group suggested Internet gaming disorder placement in Section III (Emerging Measures and Models). While the body of published evidence was extensive, the research did not apply standard diagnostic criteria; substance use disorder criteria were borrowed by some studies, and impulse control disorder or pathologic gambling
criteria were borrowed by others. The DSM-5 included pro- posed criteria for Internet gaming disorder with the hope of standardizing emerging work in the field [12]. In this proposed framework, a diagnosis is given when five or more of the fol- lowing criteria are met [11]: • Preoccupation with Internet games • Withdrawal symptoms when Internet gaming is taken away (e.g., irritability, anxiety, sadness) • Tolerance (i.e., the need to spend an increasing amount of time engaged in Internet games) • Unsuccessful attempts to control participation in Inter- net games • Loss of interest in previous hobbies and entertainment • Continued excessive use of Internet games despite knowledge of psychosocial problems • Deception of family members, therapists, or others regarding the amount of Internet gaming • Use of Internet games to escape or relieve a negative mood • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participa- tion in Internet games
CLINICAL INTERVIEW QUESTIONS TO ASSESS INTERNET GAMING DISORDER When did you begin to notice problems with your gaming? How long have you been gaming? How much time do you spend gaming each day? Week? Month? What was going on in your life when you began gaming? What was going on in your life when you began to have difficulties with your gaming? Are you experiencing or have you previously experienced any health concerns? If so, please describe. How have these health concerns been impacted by your gaming? What treatment have you received for these health concerns? Does your gaming interfere with your sleep/meal schedule? What exercise patterns do you engage in? What drugs and/or medications do you take? How much? How often? In the past?
Presenting problem
Biologic factors
Psychological factors
What types of gaming do you engage in? What do you like/dislike about gaming? How do you feel before, during, and after gaming? What are your thoughts before, during, and after gaming? Have you ever used gaming to help improve your mood or change your thoughts? In what places at home or elsewhere do you usually engage in gaming? Have you ever felt anxious, depressed, or isolated when not gaming? Has your gaming caused concerns with your family? Has your gaming caused concerns with your significant other? Has your gaming caused concerns with your social activities and friendships? Has your gaming interfered with your performance at school or work? What are your social/leisure/hobby activities? Do you believe that you have a problem with your level of gaming? What do you see as the benefits and costs of continued gaming? What is your level of commitment to change your current gaming patterns? What plans have you implemented in the past to deal with your level of gaming? Have these plans worked?
Social factors
Relapse prevention
Source: [204]
Table 3
51
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