Not All Fun and Games – 20-year-old Dies After Marathon Video Gaming Session

“He had probably been on all night, on the computer at his desk, on Facebook or gaming — one or the other,” said the father of a 20-year-old British man who died as a result of a blood clot that formed after playing video games for up to 12 hours a day. Waiting outside a job center the next day the man collapsed and died.

An autopsy determined that the man died of deep vein thrombosis, a clot formed most likely in the deep veins of one of the man’s legs due to prolonged inactivity.  “Playing video games, long car rides and long plane rides predispose you to clots,” said Dr. Phil Ragno, director of cardiovascular health and wellness at Winthrop University Hospital in Mineola, N.Y. in an interview with ABC News.

Though rare, death by video gaming is a real risk

Apart from the obvious lack of a healthy life balance, excessive gaming has claimed the lives of people from Britain to Korea and Taiwan – and it’s not just the gamer’s at risk. Last year a Korean couple starved their baby to death because they were so concentrated or raising their virtual baby. – See my blog Internet ‘Addicted’ Korean Couple Starves Baby to Death.

Gaming is so entertaining that 72% of the U.S. population plays games online[i]; gaming comes in second only to social networking in a ranking of time Americans spend online by category[ii].  In fact, the average number of hours spent by gamers each week on online gaming increased by 10%, or a total of 8 hours a week, between 2009 and 2010[iii].

An ‘addiction’ to online gaming can occur with any type of game (for women over 50 it’s more likely to be simple single-player games like Tetris and Solitaire played for hours a day) but compulsive playing is most commonly seen among MMORPG (Massively multiplayer online role-playing game) players, who represent approximately 9% of gamers[iv] .

MMORPG’s provide environments with  real-time interactions are and highly social; aspects that all gamers enjoy, but which may provide marginalized youth a sense of  control of their social relationships, providing greater success in social relationships in these virtual environments than they have in real relationships[v].

Though we typically associate addiction with substances (like drugs) there is more to addiction than brain chemistry. “Even with alcohol, it’s not just physical. There’s a psychological component to the addiction, knowing ‘I can escape or feel good about my life.’” says Kimberly Young, PsyD, clinical director of the Center for On-Line Addiction[vi].

Like addiction to drugs and alcohol, the Internet offers children and adolescents a way to escape painful feelings or troubling situations. They may sacrifice needed hours of sleep to spend time online and withdraw from family and friends to escape into a comfortable online world that they have created and shaped. Children who already struggle with emotional or psychological issues are at greater risk for developing inappropriate or excessive online habits[vii].

“[Gaming addiction is] a clinical impulse control disorder”, says Dr. Kimberly Young, Director of the Center for Internet Addiction Recovery “an addiction in the same sense as compulsive gambling[viii].”

Echoing Dr. Young’s thoughts, Keith Bakker, director of Smith & Jones Addiction Consultants says “children who play four to five hours per day have no time for socializing, doing homework, or playing sports. That takes away from normal social development. You can get a 21-year-old with the emotional intelligence of a 12-year-old”.

In a two year longitudinal study conducted by researchers from the US, Singapore and Hong Kong, in 2010, researchers found that the percentage of pathological youth gamers is similar across the world. Using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders as a guide to define the addictive condition, the researchers found between 7.6 and 9.9% of the student sample could be defined as pathological gamers.

The research concluded that video game addiction is a serious and unique behavioral problem. “Once they become addicted, pathological gamers were more likely to become depressed, have increased social phobias, and increased anxiety. And they received poorer grades in school,” said Dr. Douglas Gentile, an Iowa State associate professor of psychology. “…pathological gaming is not simply a symptom of depression, social phobia or anxiety. In fact, those problems seem to increase as children become more addicted. In addition, when children stopped being addicted, depression, anxiety and social phobias decreased as well.”

However, it’s important to note that heavy game playing in and of itself does not mean the gamer is suffering from addiction. Dr. Douglas Gentile, Director of the Media Research Lab at Iowa State University and the director of research for the National Institute on Media and the Family underscores this message saying, “It is important that people realize that playing a lot is not the same thing as pathological play. For something to be an addiction, it has to mean more than you do it a lot. It has to mean that you do it in such a way that it damages your life.[ix]

In the same way that not all heavy gamers are addicts, not all negative outcomes associated with video gaming are addiction related. Other negative effects can include physical symptoms and emotional issues. Physical symptoms may include tendonitis and seizures, short term aggression mimicking violent age-inappropriate games[x] (there is conflicting research about any long term changes in aggression), obesity due to lack of exercise, poor socialization, or a lack of attention to school, chores or work.  Negative emotional effects include depression, anxiety, social phobias and lower school performance[xi].

Compulsive internet use and Grades

Youth who are heavy users of media are more than twice as likely to say they get poor grades (mostly C’s or lower) as light media users. Heavy media users are also more likely to say they get into trouble, are sad or unhappy, and are often bored[xii].  These results remain consistent regardless of factors such as age, gender and race.

Set boundaries

If your child just spent an entire beautiful weekend sitting indoors tweaking her Facebook page, foregoing a trip with the family to an amusement park, she may be showing signs of addiction. Many parents feel torn about limiting their children’s time on the computer.

If a teen is struggling socially, some parents believe any human interaction, even if it comes through the computer, is preferable to none. And with teens that are risk-takers or have questionable taste in friends, some parents feel they can better monitor and keep their children safe by letting them stay home, downloading music files and creating quizzes for their Web pages. Other parents just want to avoid the tantrums, the cold shoulder, or the arguments that flare whenever the issue of computer time management comes up[xiii].

Begin with creating boundaries. While savvy or compulsive youth may figure out how to circumvent family safety tools like content filters, time restrictions, and reports of which websites they’ve visited, these technology tools are still important parts of prevention and should be in place on computers, game consoles and phones.

Discuss the problem openly. Before beginning a conversation with your child, consider the message you want to deliver, and the tone you use. Avoid blame and focus on your concern about some of the changes you have seen in his or her behavior and refer to those changes in specific terms: fatigue, declining grades, giving up hobbies, social withdrawal, etc… Anyone struggling with an addiction is likely to feel threatened by any intervention and respond emotionally. Be prepared for an emotional outburst laden with accusatory phrases designed to make the parent feel guilty or inadequate[xiv]. It is important not to respond to the emotion—or worse yet, get sidetracked with a lecture on disrespect. Acknowledge your child’s feelings but stay focused on the topic of his or her Internet use.

Talk with your child about the settings you’ve put in place as well as why these boundaries are there. Help them understand that it is for their own protection and ask them to collaborate with you in ensuring they have a healthy balance in their lives. Put them on the honor system to keep the log themselves for a week or two to build trust between you. If they balk at this idea or clearly lie in their log, you are likely dealing with their denial of addiction[xv].

Part of boundary setting is gaining the skills to monitor those boundaries. This may require that you get a little more computer savvy yourself. Check browser history folders and internet logs, learn about technologies for monitoring online use and install these tools. If you don’t already know how to do these things, a simple search will provide you with step-by-step guides, or you can ask someone you know who is more computer savvy.

Refusing to let your child or teen use the internet at all is not a solution. The internet has become a critical part of lives in the 21st century. They need to use the internet for school projects, communication, and fun. As parents and caregivers, our job is to ensure that youth learn how to use these tools in a healthy, balanced, and responsible manner and this simply cannot be accomplished by banning technology. Work with your child to set time and website limits, and you may need to be more physically present as they learn to cut back their use. Allow perhaps an hour per night after homework, with a few extra weekend hours. Stick to your rules and remember that you’re not simply trying to control him or her – you are working to free them of a psychological dependence[xvi].

Increase participation in other activities. One way to help children from developing an internet addiction or problem is to be sure they are actively engaged in other activities like schoolwork, sports, arts, entertainment, social interactions. Participation in these activities is also a critical step in helping youth struggling with an internet compulsion to regain the balance in their lives and reduce depression, guilt, or other feelings they may experience as part of the negative side of their addiction.

Enlist the support of your child’s network. If your child goes online from other family members or friends homes, ask that they help ensure your child is adhering to their boundaries and help suggest alternative activities.

As parents and caregivers, understanding how to differentiate between ‘normal’ internet gaming and compulsive gaming is critically important for knowing when to seek help for concerning behavior. Internet usage naturally ebbs and flows to accommodate other activities and interests among healthy internet users.

Usage may spike because your child has just started playing a new game or for some other short-term interest. While potentially time consuming and engrossing, this is very different behavior than that of youth who spend virtually all of their waking hours, week in and week out, gaming behind an internet connected screen, ignoring relationships, homework, and the world.

If you are unsure whether your child or teen falls into the latter category, compare their behavior to the list of warning signs below. As you review the list, keep in mind that if a child or teen exhibits a one (or a few) of these behaviors, it may or may not be cause for concern. For example, plenty of teens prefer to spend time online rather than with family, we all lose track of time online on occasion, and a new game can be very compelling.  On the other hand, if you read through this list and most of these signs are visible in your child, it may be time to consider the best course of action.

 

Warning signs of compulsive internet use[xvii]:

  • Preoccupation with the internet; or specific internet destinations
  • Defensive about time spent online gaming
  • A heightened sense of euphoria while involved in gaming
  • Loses track of time while online
  • Sacrifices needed hours of sleep to spend time gaming
  • Becomes agitated or angry when not online or online time is interrupted
  • Spends time online in place of homework or chores
  • Prefers to spend time online rather than with friends or family
  • Disobeys time limits that have been set for Internet usage
  • Lies about amount of time spent online or “sneaks” online when no one is around
  • Seems preoccupied with getting back online when away from the computer
  • Loses interest in activities that were enjoyable before he or she had online access
  • Escapes into the internet to avoid responsibilities, escape painful feelings or troubling situations
  • Depression

There is no shame in seeking additional help for your child. If your child or teen struggles with an internet addiction and your intervention efforts are not enough, seek help. Your primary care physician or your child’s school counselor should be able to suggest resources, you can search online for information and resources in your area, and the resources cited in this document may also be of great use as you look for help.

There are a couple of Web sites that you and your child can visit together to assess their level of addiction. Try the addiction quizzes at netaddiction.com or mediafamily.org. Even if you don’t actually believe your child is addicted, the tests are a good way to initiate some dialogue and get them thinking about how they are spending their time.


[iii] According to Online Gaming 2010, the most recent report from leading market research company The NPD Group, http://www.npd.com/press/releases/press_100302.html

[iv] www.ama-assn.org/ama1/pub/upload/mm/467/csaph12a07.doc and Entertainment Software Association. 2005 Sales, Demographic and Usage Data: Essential Factors About the Computer and Video Game Industry. Available at: www.theesa.com/files/2005EssentialFacts.pdf.  January 2, 2007 and Olson CK.  Media violence research and youth violence data: why do they conflict?  Acad Psychiatry. 2004;28:144-50.

[xii] Generation M2 Media in the Lives of 8- to 18-Year-Olds   http://www.kff.org/entmedia/upload/8010.pdf

[xvii] Compiled from: http://www.safetyweb.com/internet-addiction#References, http://www.video-game-addiction.org/symptoms-computer-addiction-teens.html, and . Kimberly Young, Director of the Center for Internet Addiction Recovery, identified the following potential warning signs for children with pathological Internet

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