AMES, Iowa – People play video games for different reasons. Some play for entertainment or for the competition, while others game as a way to cope with stress or anxiety.

Understanding the motivation to play may be key to identifying some of the causes of gaming disorder, said Douglas Gentile, a professor of psychology at Iowa State University. For a paper published in the journal Psychology of Popular Media Culture, Gentile and his colleagues surveyed college students about their frequency of video game play, coping strategies, anxiety and symptoms of various mental illnesses including gaming disorder. The researchers found using video games as a coping mechanism for anxiety predicted symptoms of gaming disorder, and higher levels of stress increased the risk.

“For most people, playing video games is a normal, healthy way to relieve stress, but some reach a point and can no longer control that behavior. Loss of control is, of course, a hallmark of addiction,” Gentile said. “If students in the study were more stressed and they played video games specifically as a way of coping, then their risk of dysfunctional symptoms increased.”

The World Health Organization classified gaming disorder as a mental health disorder earlier this year, but Gentile says there is still a lot to learn about potential risk factors for addiction. This paper is one of the first to provide evidence that using video games to cope with anxiety is an important factor to consider when diagnosing or treating video game addiction.

Gentile is quick to point out not all video game play is bad. Similar to having a drink after a difficult day at work or following a stressful situation, Gentile says drinking – or video game play – is not a problem, until it is.

“The issue is when the gaming begins to disrupt normal and healthy functioning. This may mean they’re getting worse grades, they’re lying to people about time spent gaming or they’re performing poorly at work,” he said.

Frequency vs. motivation

In their paper, the researchers referenced a 2011 article from The Guardian, which featured the story of Ryan Van Cleave, an English professor who gamed to cope with work-related stress, relationship issues and day-to-day setbacks. The researchers write that Van Cleave’s experience illustrates video game addiction is more than prolonged play. While nearly 25 percent of adult men gamers play four or more hours per day, Gentile’s previous research found gaming disorder rates are between 2 and 8 percent of gamers.

Gaming disorder is commonly linked to excessive play and therefore people assume the solution is to simply limit the frequency of play. Courtney Plante, lead author and a former postdoctoral researcher at Iowa State, says while frequency is associated, their research suggests addiction may be more about video game play as a means of coping with stress or setbacks.

“It’s possible that people playing for recreational or social reasons may be less at risk for addiction than those playing to escape anxiety or stress, but additional research is needed,” Plante said. “We do know that dysregulated coping is a risk factor for substance addictions in general and our research shows gaming disorder is similar to other addictions.”

Diagnosis, treatment

The research supports previous studies – including a 2011 paper by Gentile, published in Pediatrics – that find gaming disorder may exist along with other mental disorders, such as depression, anxiety, social phobias and ADHD. To effectively diagnose and treat, Gentile says clinicians need to understand how one may be related to the other by asking clients about their media habits.

For example, Gentile says many first-year students will seek counseling services in response to poor academic performance. If a therapist only asks about study habits, sleep and note-taking, without asking about gaming habits, it may be difficult to treat the problem.

The researchers acknowledge the study is correlational, so they cannot say whether anxiety causes the use of video game play as a coping strategy, which in turn causes video game addiction. Gentile says his team is now working on a longitudinal study to determine whether youth who use games as a coping strategy are likely to develop symptoms of video game addiction.

Christopher Groves, Adam Modlin and Jorge Blanco-Herrera, all former graduate or undergraduate students at Iowa State, contributed to this research.