Mental disorders associated with video game addiction

Why is dual pathology so common in behavioral addictions?

Elena Flores Márquez

Clinical psychologist. Adolescent Addictive Behaviors Unit. Mental Health Area

Hospital Sant Joan de Déu Barcelona

When an addiction occurs together with another mental disorder, we speak of dual pathology , very common in behavioral addictions. There are studies, for example, that say that up to 86% of cases of video game disorder meet criteria for another mental health diagnosis. Therefore, when we observe negative consequences derived from the overuse of screens, it is always necessary to evaluate whether they represent a diagnosis in themselves, or rather they are a symptom of an underlying problem that, sometimes, has not yet been diagnosed. This happens because both disorders influence each other , and what may start as a simple symptom at the beginning can become a diagnosis in itself.

To understand it better, imagine the case of a boy with depression who begins to isolate himself at home and stops doing all the activities he used to do (going to class, extracurricular activities, meeting friends, etc.), and in this moment of isolation and loneliness he begins to play more because it is the only thing he feels capable of doing (it requires little effort, he does not have to face people or give explanations, he can do it from home, etc.). It is likely that the time spent using screens will increase and it will be the only activity that helps him escape his discomfort, generating a loop of increased use and negative consequences derived, which could end up forming a video game use disorder that is added to the depressive disorder. In these cases, sometimes the depressive disorder may have gone unnoticed and the reason for consultation may be directly the concern about the use of screens; This is why it is important to carry out a comprehensive analysis of the relevant factors in the acquisition and maintenance of addiction to detect possible comorbid disorders (disorders that occur at the same time).

This relationship between disorders is bidirectional, that is, either one can occur first and lead to the other. Let's now imagine the case of a boy with such excessive use of video games that he loses interest in those activities he previously did and begins to isolate himself at home and loses contact with the friends he had, his academic performance worsens, he begins to miss classes and begins to have conflicts at home because of this issue. All these consequences derived from video game disorder put him in a situation of high vulnerability to having another mental disorder , such as depression or anxiety disorder.

Up to 86% of cases of video gaming disorder meet criteria for another mental health diagnosis. The relationship between the disorders is bidirectional, meaning that either can occur first and lead to the other.

There are also cases in which the dual pathology begins in a very parallel way , making the analysis of the situation and the differential diagnosis even more difficult, since there are vulnerabilities and risk factors shared between both diagnoses, in addition to common symptoms. An example of this would be when there is a life stressor such as a break with a person's previous life. Let's imagine an adolescent adapted to his environment with certain personality characteristics (shyness, tendency to rumination, insecurity...) who has to move and has to make a change of home, town, school, friends... This could leave him in a situation of isolation and a feeling of unwanted loneliness that would have effects on his mood, but also on his gaming behavior.

Given the high prevalence of dual pathology and the multiple possible interactions, both in terms of multicausality and the variety of comorbid disorders, it is essential to carry out careful detection and evaluation , especially because we know that this conditions both the intervention and the prognosis of the disorders.

Warning signs of video game addiction

Most frequent comorbidities in behavioral addictions

The comorbidities that we most commonly find in behavioral addictions are:

Affective disorders, such as depression.
Anxiety disorders. One very common one is social or school anxiety.
Behavioral disorders.
ADHD.
Autism spectrum disorder (ASD).

In addition to occurring alongside other mental disorders, behavioral addictions in adolescents are also related to aspects such as poor school performance and problematic family relationships , as well as other psychological problems such as:

Insomnia.
Stress.
Hostility.
Self-harm.
Deficits in social skills.

It is important to highlight that adolescence is a key period for the development of social skills, and excessive use of screens can lead to a decrease in face-to-face interactions, causing young people to end up being less socially skilled due to a lack of real practice. As a result, their fears about relationships increase and they tend to avoid them , and a kind of "vicious circle" ends up developing in which they do not relate because they do not feel safe and do not acquire security in relating because they do not practice. Loneliness is a key factor for behavioral addictions and for most associated disorders, so it is advisable to take it into account both in the detection of the disorder and in prevention and treatment, and to guarantee tools to improve social skills and opportunities to develop them.