AMA Weighs in on Gaming and Internet Addiction

In 2006, the American Medical Association decided to do its part to contribute to the body of knowledge associated with “gaming addiction,” violence and “Internet addiction.” The report — which doesn’t rise to any traditional academic standard for peer-reviewed research, such as a formal literature review — was just published (AMA Report on Internet and Video Game Addiction (PDF)).

How are the report’s findings when it comes to things like Internet addiction and video game addiction?

Well, let’s get to the juicy “Internet addiction” first.

The history of “Internet adddiction” is that it was a term that was coined in 1996 in a poster at the annual American Psychological Association convention. The term came from a small study that simply changed the word “gambling” in the criteria of “pathological gambling” to “Internet use” and found, not surprising, that a self-selected sample of people identified with the criteria. (The researcher could’ve easily done the same thing with the words, “shopping,” “watching TV,” or “eating chocolate,” and found similar results.)

What does the report say about this “disorder”?

This term seems to have been coined in the 1990s when researchers were attempting to describe a constellation of behaviors observed in persons using the Internet to such an extent that it began to cause other aspects of their lives to become dysfunctional. The DSM-IV disorder most similar to the pattern of behaviors observed with overuse of video games is pathological gambling.

The AMA report puts the chicken before the egg — the label came specifically from the pathological gambling criteria, so I sure hope the two criteria look very similar. But unlike the criteria for pathological gambling, which were empirically derived, the criteria for “Internet addiction” were simply copied from the existing pathological gambling criteria.

If the AMA report is sloppy in understanding the etiology of this “disorder,” I can’t help but wonder where else they were sloppy in this report.

The report also leaves out any mention of studies critical of “Internet addiction.” Why is that? Shouldn’t a report of this nature try to be balanced in its efforts and findings?

Now traditionally, when one goes to the trouble of writing a report and looking at studies, one would think one’s conclusions would logically follow.

For this report, this pattern of heavy video game playing is referred to as “video game overuse.”

But the authors of the report never bother to define “overuse.” They just refer to it constantly, as does the research, without ever agreeing upon a single, accepted definition.

Which is exactly the problem in the research literature. There is no universally accepted definition of “overuse” — of the Internet, of video games, of TV watching, etc.

So in the report, I read sentences like,

However, as with findings on long-term aggression, there is currently insufficient research to definitively conclude that video game overuse is an addiction.

one would expect the report authors not to make recommendations. And yet:

That our AMA strongly encourage the consideration and inclusion of “Internet/video game addiction” as a formal diagnostic disorder in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders-IV.

How does it follow that, if there is yet insufficient research, it should be included as a formal diagnosis? Indeed, the entire diagnostic system is based upon there be more than sufficient evidence and agreement amongst experts on a disorder before it is accepted in the DSM.

Ars Technica, a technology website, also gives us its two cents:

Overall, the committee seems to have produced a fine report that both accurately affects the current state of knowledge and puts the impetus for acting on it where it belongs: on parents, acting in consultation with family physicians.

Yes, a “fine report” if you enjoy illogical recommendations that don’t follow from the report’s findings, a biased sampling of the research it examined, and believing the hype surrounding “Internet addiction” and video game “addiction.” Ars Technica should stick to, well, technical matters.

PS – For the record, the AMA does not publish the DSM, the American Psychiatric Association does. Anything the AMA recommends is purely that — simply a recommendation. The process for getting a diagnosis into the DSM is far more rigorous and time-consuming than simply one organization “recommending” something be included.

PPS – 26-Jun-2007 Update: As expected, the AMA backed down from this proposal and decided not to consider playing video games too much an “addiction.” For now. That’s good news for all of us who read “too much,” watch “too much” TV, eat “too much” chocolate, or talk on the telephone “too much.”