In ICD II (eleven) gaming disorder is officially or formally defined.

World Health Organization

recognized gaming disorder as a psychiatric condition. In ICD-II gaming disorder is under addiction
and under disorders due to addictive behaviors. ICD-II behaves gaming disorder such as gambling
disorder. They put these disorders close to each other. Gaming disorder has two types:

• gaming disorder prominently online

• gaming disorder prominently offline

ICD-II in other words World Health Organization sees gaming disorder as an addictive behavior.
Gaming disorder criteria in ICD-II:

• Gaming disorder is defined as a pattern of gaming behavior (digital-gaming or video-gaming)

characterized by impaired control over gaming, increasing priority given to gaming over
other activities to the extent that gaming takes precedence over other interests and daily
activities, and a continuation or escalation of gaming despite the occurence of negative
consequences.
• For gaming disorder to be diagnosed, the behavior pattern must be of sufficient severity to
result in significant impairment in personal family, social, educational, occupational or other
important areas of functioning and would normally have been evident for at least 12 months.

Following World Health Organization APA and DSM-5 defined internet gaming disorder but we
cannot diagnose anyone with internet gaming disorder according to DSM-5 because this disorder is
not officially diagnosed. It is under the further investigation topic. DSM-5 suggested some criteria for
internet gaming disorder. If you have 5-9 criteria you may diagnosed with internet gaming disorder
maybe in the next version of DSM but not now. According to ICD-II we can diagnosed with gaming
disorder but not according to DSM-5.

According to ICD; gaming disorder

According to DSM and APA internet gaming disorder

APA'S symptoms for internet gaming disorder:

Ø preoccupation gaming -thinking or fantasizing about gaming during times of nonplay.

Ø tolerance (like addicting a drug or a substance) - increasing amounts of time spend on games
to feel desired effects (excitement, satisfaction)
Ø withdrawal (like addiction a drug or a substance) restless, irritated, angry, frustrated, angry
and sad.
Ø persistence - enduring desire for gaming or unsuccessful attempts to stop, control or reduce
gaming.
Ø escape - escape from or relieve negative mood states, such as helplessness, guilt, anxiety or
depression
Ø Problems- continued gaming despite being aware of negative consequences of this behavior
for central areas of life
Ø deception- lying to others about or covering up the extent of their gaming behaviors.
Ø displacement- gaming behavior dominates, diminishment of other social and recreational
activities.
Ø conflict - losing or nearly losing an important relationship or opportunity relating to schooling
or employment

Game Genres/ Types

There are too many types game but I put three of them.
 1. Action Games: It requires eye and hand coordination and motor skills. You as a player control
all the actions of game characters so you are center of game. It has some subtypes:

platform games: Super Mario, shooter games: Call of duty, Battle Royals: Fortnite. These games
are characterized by some features you start with minimal equipment and search for new
equipment, weapons, try to stay alive and safe.

2. Role Playing Games: MMORPGs: World of Warcraft. In these games you create a character,
this character grows over the time. After growing, you face with challenges or you can defeat
someone and gain experience points. These points can represent your progress. You can
acquire new abilities with this progress. The most popular type of MMORPGs is World of
Warcraft. In MMORPGs you can interact with other players. You try to complete some quests
or you try to strength your character at the same time you can interact with hundreds of
people who play this game. It makes these games special.
3. Strategy Games: You have to be careful and do some decisions, skillful planning, get a
victory.
Multiplayer Online Battle Arena: League of Legends. You control your character and fight
with some people who are real and maybe elder. Strategy games are fusion, a combination
of other types of games. It involves action, role playing. These games have some impacts on
our psychological well being.

Why do people enjoy playing video games?

v The reward system of brain: This system is also related to substances. While taking some
substances your brain's reward system become active. Every level you reach or every
progress you get, every mission you completed provide a small hit for dopamine so the
reward system of brain.
v Operant Conditioning/ intermittent variable rewards: It is the most popular explanation and
comes from learning theory. Let's think about social media usage. Social media depends on
reinforcement schedules. They use intermittent variable reward. You never know when you
obtain a like. Operant conditioning which takes place social media platforms changes and
shapes our behaviors dramatically. Playing a game also uses intermittent variable reward.

There are two hypotheses about who play these kinds of plays: The rich get richer hypothesis and the
compensation hypothesis.

§ Rich get richer hypothesis: It says that internet games are used by people who are already
good at making friends. People play these games to have more friends or enhance their
relationship/ friendship.
§ Compensation hypothesis: People especially young/ teenagers/ adolescents use internet
because of their problems with face to face interaction. They use virtual environment and
video games to interact other people.

Although these two hypotheses are opposite to each other sometimes the first one is true
sometimes the second one. For example the compensation theory is true for MMORPGS games, the
rich get richer is true for battle or strategy games.

Gaming disorder is associated with increased colorize intake which leads to obesity. It can be a silent
risk of gaming disorder. Another important discussing topic is heteronormative gender roles. The
prototype of woman and man in the games strength the heteronormative gender roles and it is
another risk factors.

Some Risk Factors for Gaming Disorder

Some people have higher risks for GD. The first risk factor is personal vulnerabilities such as low self
esteem. Another risk factor is social influences like peers or social networks. The last risk factor is
constant accessibility to gaming activities like accessing easily from bedroom. There may also be
influence of game activity itself on problematic gaming and gaming disorder. Gaming itself may be a
risk factor. What does it mean?
In modern video games there are complex dynamics and variances for digital entertainment. They
serve as an entertainment but people use control schemes (keyboard, controller) to manipulate
some images to reach an outcome which can be defined as success or failure.
Games differ to according to genre (shooting, role playing, strategy) but at the same time you can
use different platforms to play like smartphone and PC. You can play with a player or an environment
(mood). You can play this games online or offline (connectivity). Your aim can be building, racing or
destroying something (objective).

The research shows that the most addictive games are World of Warcraft and Everquest. The other
important finding from literature is online multiplayer games are more addictive. If you play real
people and player the risk for addiction increases. Beyond being adolescent or female/ male we have
to mention about types of games for gaming disorders.

Why do people enjoy playing games?

Games serve us unlimited experience of winning and losing. They include narrative and characters for
us you can go into a narrative and create a character. The marketing strategy is also important. They
make us play longer and regularly. They use different elements of games and they have less
emphasize on winning. These games decrease the demands from players to keep you play. They try
to fulfill your psychological needs, make you experience different emotions in these games. You can
pass time, explore new things and world and escape from reality. They try to keep you play regular
and longer. In these games also you can socialize and interact with other people. You can attach to
virtual items, actions, identity because games are also have features that lead players to
psychopathological attachment these virtual things above.

A research shows that people value their virtual (game) items and relationships more than real
goods, relationships. Collecting and completing a game is more than a leisure pursuit. Also, it is a
conscious process of acquiring scared items to achieve psychological fulfillment.

Clinical psychology highlights the types of thinking which is over valuing or over reliance. These
thinking styles are associated with self worth and identity. Over value is tendency to over value the
importance of game rewards. Over reliance is the tendency of over relying of self worth and identity.

The endowment effect: It is a business strategy used by marketing. There is a game economy. This
effect tries to convince players that further gaming items have greater values than items are acquired
through skillful play. They put more value future items, items that you give money for them are more
valuable than ones you get through your skills. They also use predatory monetization scheme which
is another important thing. You have to pay something to go further in game but you face this
situation after reaching point like middle of game. This lead to problematic gaming.

MMORPG is defined as massively multiplayer online role- playing game. This type of game may be
more problematic for certain users.
Individual Differences and Risk Factors

The first important risk factor is being male. Males are at greater risk for developing GD. They play
more frequently than females. Age has an inverse u- shaped relationship with problematic gaming.
Adolescents play more than other ages, peak is in adolescence because there are some factors about
neurobiology, development and cultural reasons. Their prefrontal cortex are still developing. They
need social belongings at the same time they challenge with authority. They face with some cultural
expectations like getting new responsibilities and games benefit them to escape these
responsibilities and real life stressors as well. There are also other psychological and personal
variables which are seen as risk factors for GD: Greater impulsivity, neuroticism, introversion, lower
agreeableness, lower conscientiousness, low openness to experience, aggressiveness, rule- breaking,
depression, trait anxiety, schizotypy, narcissism. Neurobiological variables: Neurobiology studies
identified some individual differences that make contribute to poor self regulation and decision
making strategies. Some people differ in terms of executive factors, attention, processing and
decision making. The people who are more risky for gaming disorder are making poorer decision in
the risky conditions, falling to account for objective probabilities, demonstrating response inhibition
deficits and being less capable of delaying gratification for a larger reward.

Findings about Video Game Type and GD

°°°°° MMORPG and RPG playing were more strongly positively correlated with GD scores.

°°°°° MMORPG players report greater life interference ( poorer sleep quality, academic
performance).

°°°°° There are some associations between social features of game and problematic gaming in terms
of socializing motives. MMORPG games include too many people who interact each other so the
researchers say that if you have a problem with socializing you can play these types of games more
than others and you are at risk for GD. However some other researchers said that role playing,
advancement, escapism, immersion are stronger predictors of GD. (Escape from reality in MMORPG
cause GD rather than socializing motivation according to this claim, but according to socialization
people who have problems with social interactions play these kind of games which in turn cause GD.

°°°°° MMORPG players have severe GD scores, higher on novelty seeking, higher on depression,
higher on social anxiety, lower on self- esteem.

°°°°° RPG tended to attract more anxious gamers who are lacking in real world skills and confidence.

°°°°° We observed that people who diagnosed with GD have lower happiness, seeking social
relationship, loneliness& boredom.

°°°°° Impulsivity (urgency trait: tendency to act rushly while facing with intense negative emotional
context) is also risk factor important for gaming disorder.

In Summary

Role playing games which include MMORPG have the strongest association with problematic gaming
and GD comparing to other video games genres.

Players with higher impulsivity, risk taking, achievement and escapism motives tend to be at greater
risk of GD.

Not all the game types share the same individual risk profile.
For example; MMORPG/strategy oriented games---> lower scores on sensation seeking, self- esteem,
impulsivity but higher scores on social anxiety and sociality, as compared to players shooting games.
MOBAs & Battle Royal Games ---> impulsive, sensation- seeking players.

Strong risk factors: being male, adolescent, gaming on a daily basis for long periods, lacking social
support.

There also specific risk factors that tend to align with certain game types.

If you are the player who have some obsession with creating a character, you don't like playing game
and spend your all time creating a character or watching some YouTube videos and Twitch rather
than playing can we define these types of behaviors as a gaming behavior? Should all behaviors
include and/or implicate gaming products be defined as gaming behavior?
According to teacher they are not seen as gaming behavior. It is another thing to investigate.

ATTACHMENT

Bowlby is the finder of this concept and first person who mention about attachment.

°°°°° The attachment style affects individual's future psychopathology. Especially insecure attachment
is highly correlated with psychopathology. Attachment has so many consequences for
psychopathologies and psychological well being. Our relationships can be affected by our
relationship with caregivers.

°°°°° Attachment behavior is instinctive.

Definition and History of Attachment

Attachment theory is firstly described by Bowlby. He is interested in working with children as a

psychiatry and he is also a psychoanalysis. He search the effects of separation between the parents
and infants. He observed too many children and too many mother and their relationship, explained
attachment theory. Bowlby observed that children experienced intense distress when they are
separated from their mothers. All of these children were cared and feed by other people but mother
is an important figure for their development or behaviors.

Why is mother so important for any child? Why do we need to attach someone else?
The answers for second question: To feel safe.

We attach someone else to survive. Before feeling safe we need other people to survive. If you are
alone and there is no one to care you, you can not survive. The basic function of the attachment is to
survive.

Bowlby observed that unstable relationship between children and mother affected child's behavior
negatively.

Ainsworth as a psychologist, she attended Bowlby's research team and analyzed records of children
who are together or playing with their mothers. Their studies were influenced by Lorenz and
Harlow's experiments.
Horlow worked with monkeys. He separated monkeys from their mothers after birth. He used some
figures instead of their mothers. There were two types of mother figures. The first one was made
from soft material while other was made from wires. Both figures provided milk so monkeys got their
basic/physical needs from these. The results were so surprised. Monkeys tried to use mothers who
are from soft material. The monkeys who attached to wire fake mother behave negatively like