Measuring gaming disorder

Brains and genetics lead the way

Issue #16 of LFG: Learning from Games is an overview of how we could identify (and in the future, predict) gaming disorder using biomarkers. Content warning: I don’t talk specifically about addiction, but there are hints of it sprinkled in the post. If you are sensitive to that content, please skip this post!

Hello JOMT Reader!

Everything in moderation.

We’ve all heard this saying, applied to pretty much everything we do, eat, or drink. It’s a good motto to live by — otherwise, we risk turning yellow (if you eat too many carrots)¹ or feeling like the world is going to end (from too much nutmeg).² The key to life is balance.

It won’t be a surprise then, that excessive gaming can also be bad for you. But it took a while to decide on what was considered excessive. Only two short years ago in 2022, excessive, uncontrolled gaming was officially included as a disorder with the publication of the 11th revision of the International Classification of Diseases (ICD-11). According to ICD-11, too much gaming is called gaming disorder, which includes both online and offline gaming.

There are a few ways gaming disorder can manifest³:

1. Impaired control over gaming, which includes things like how often someone plays a game, how long they play, and whether they are able to stop playing at will.

2. Increased priority given to gaming, to the extent that it takes over other interests and life activities.

3. Continuation or escalation of gaming, despite negative consequences.

These traits are outward manifestations of gaming disorder, often diagnosed by a psychiatrist. It’s also not the complete set of symptoms: all or most of these symptoms have to be true for someone to be diagnosed. Otherwise, on point #2 alone, I would be diagnosed with gaming disorder.⁴

But there are other, measurable ways to look at gaming disorder, collectively called biomarkers. I love biomarkers because with the right measurements, they can give you a more accurate picture of what’s going on with you. In some cases, they can even predict what might happen to your body, helping you to take proactive steps towards your health.

So, today’s post is all about biomarkers, focusing on gaming disorder. What are the invisible ways in which our bodies change when afflicted with gaming disorder?

Gaming disorder can change brain waves

Our brains are pretty much always active, even while we are sleeping. That activity can be measured as brain waves, which are tiny repetitive or rhythmic changes to electrical voltages in the brain. There are five basic brain waves that we know about:

Figure taken from https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/brain-waves. The top two waves (gamma and beta) are also known as fast brain waves; the bottom two waves (theta and delta) are also known as slow brain waves.

1. Alpha waves occur during relaxation like daydreaming or sleeping

2. Beta waves occur with an active mind; too many beta waves can signal stress

3. Gamma waves occur during mental activities like problem-solving or studying

4. Delta waves occur during deep sleep before and after REM sleep (dreaming state)

5. Theta waves occur during periods of creativity as well as REM sleep

Individuals with gaming disorder show higher levels of delta and theta waves, which could indicate difficulties with sleep but also attention and self-control. They also had lower levels of beta waves, pointing to possible issues with impulsivity and concentration.

Different parts of the brain light up in those with gaming disorder

There are a lot of different parts to our brains, each becoming active and “lighting up” in response to something we are doing or feeling. These patterns of brain activity can be measured using functional magnetic resonance imaging (fMRI), a very accurate way to measure changes to blood flow in the brain.

Image taken from https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000900#pbio-3000900-g004. I included it as an example of what a fMRI image might look like; the image here isn’t related to the findings I described in the text.

Parts of the brain responsible for reward processing (that feeling of accomplishment) light up in response to gaming cues in individuals with gaming disorder. At the same time, the activity in the part of the brain responsible for planning and decision-making decreased. These two patterns of brain activity were linked to other behaviours like increased risk-taking.

Finally, parts of the brain responsible for reinforcement learning (learning from past mistakes) didn’t activate strongly in individuals with gaming disorder, which might lead them to continue gaming despite negative consequences.

Genetics can have a role in the risk for gaming disorder

Dopamine, also known as the feel-good hormone, is released when you do something pleasurable. In the long past, it used to be things essential for survival: eating, drinking, and reproduction. In modern times, anything that makes you feel good, including gaming, will release dopamine.

But that dopamine doesn’t last forever and our body breaks it down. But there is evidence that individuals with gaming disorder carry a variation of a gene that allows them to break down several times more dopamine than others. Meaning, that the feel-good sensation doesn’t last as long as it does in others and more gaming is needed to achieve a longer feel-good sensation. It’s similar to how people with the gene for breaking down alcohol can drink more without getting the Asian blush (like I do).

Other genes, including one also associated with depression, were found to be altered in individuals with gaming disorder.

Final remarks

These are some of the more specific biomarkers that were found to be associated with gaming disorder. Others, like levels of certain chemicals in the blood, the length of the index finger compared to the ring finger, and blood pressure/heart rate, are too non-specific or plain weird (length of fingers?⁵) that they will only be mentioned in passing here.

I hope what is clear though is that gaming disorder is not a simple condition. Just playing a lot of games doesn’t immediately put you at risk of gaming disorder. But that also means treatment for gaming disorder isn’t merely a matter of taking games away. My hope is that the biomarkers here will help tailor the right treatment for the right patient.

In the future, maybe these biomarkers can help prevent gaming disorder from taking hold in the first place.

If you want to read more about other biomarkers, you can access the article here for free (warning: it’s a fairly dense read): https://www.mdpi.com/2077-0383/13/17/5110

If you liked what you read, please consider giving this post a like and sharing it with your community!

1. https://pubmed.ncbi.nlm.nih.gov/37916485/
This is a review article about how carotene found in carrots can turn your skin yellow.

2. https://pubmed.ncbi.nlm.nih.gov/1642706/
The title of this article says it all: Acute nutmeg intoxication. Apparently, it is used for its hallucinogenic properties (please don’t try this at home).

3. https://icd.who.int/browse/2024-01/mms/en#1448597234
This is the link to the description of gaming disorder in the International Classification of Diseases (ICD-11).

4. I mean, I don’t deprioritize things like eating, exercise, or family time. But I do prioritize gaming over other activities (sometimes sleep)…hence, this Substack! But no, I’m pretty sure I don’t have gaming disorder.

5. Apparently, this has to do with exposure to testosterone as a baby. This might be a bit of an overstretch to link it to gaming disorder, in my opinion.