Prof. Wai Chen, BM, MPhil(Camb), PhD, MRCP, MRCPsych, FRANZCP; Professor of Youth Mental Health and Developmental Neuropsychiatry, Fiona Stanley Hospital, SMHS; Professor, psychiatry discipline lead, Curtin Medical School, Curtin University; Professor, Curtin enAble Institute, Curtin University; Adjunct professor, Postgraduate School of Education, UWA; Adjunct professor, Murdoch University, WA; Visiting Professor, Centre of Excellence in Medical Biotechnology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand\ Dr. Daniela Vecchio, MD, FRANZCP, MHA, MPH; Consultant Psychiatrist and Head of Service – Fiona Stanley Hospital, SMHS
The critical relevance of a specialist clinic for gaming disorder (GD) was first recognised by a group of clinicians at Fiona Stanley Hospital (FSH) approximately four years ago. During the COVID-19 pandemic, FSH clinicians noticed a steep rise in gaming, GD and related problems in adolescents and young adults, presenting to the emergency department (ED), youth and adult mental health and medical wards.
The first publicly funded Gaming Disorder Clinic (GDC) in WA was conceived and piloted in 2021 within the FSH Alcohol and Other Drug Service. To our knowledge, the GDC at FSH is unique in Australia, as other international centres tend to have clinics as outpatients or detox camps, rather than one embedded within an acute hospital setting.
From our early observations, GD is often hidden, but in many cases drives the acute conditions leading to hospital admission to one of our acute units. This includes severe mood and anxiety disorders, psychotic presentations, suicidality, or other medical emergencies. Typically, patients do not self-identify as having a GD problem, despite experiencing severe symptoms and impairments, directly or indirectly leading to the acute hospitalisation. The underlying GD problems are only revealed when clinicians ask direct questions on specific GD symptoms and impairments. For some, GD leads to school refusal, poor attendance at university or higher education, unemployment, gambling debts, and aggression; and for others, suicidality and even an acquired brain injury (in one extreme case due to erroneous administration of insulin while preoccupied with excessive gaming, leading to hypoglycaemic coma).
Our early clinical experience is likely influenced by the referral bias associated with our service, located and embedded within a statewide acute hospital. The clinic was initially not known in the community or to GPs. As such, patients who self-identified as having GD would not have been referred by their GPs, teachers, and parents, due to lack of awareness of the clinic. Despite this limitation, we found consistency with international literature (e.g., Cheng, 2018) that GD arises from a complex interplay between social and familial factors, as well as psychiatric and neurodevelopmental disorders. Specifically, these include attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), mood and anxiety disorders, social phobia, obsessive compulsive disorder, and substance misuse.
We have also encountered other forms of internet and digital addictions. For instance, female patients tend to present with problematic social media use and copying of harmful behaviours seen in online content, such as cutting, self-harm, and eating problems.
Aside from formal psychiatric disorders, we also found other social and familial correlations and likely determinants of GD not otherwise classifiable by formal diagnostic criteria. These include family problems (conflict, discord, communication breakdown), educational failure, bullying, social isolation and peer rejection. Some patients live within unbearable social situations, such as exposure to domestic violence, abuse, or severe bullying; and escaping into online worlds initially provides some form of solace and comfort. But these coping strategies become addictive over time.
The GDC sees a range of patients. Their primary problems include GD, hazardous gaming, problematic internet use, social media addiction, and pathological gambling, with occasional cryptocurrency gambling addiction and pornography addiction.
Our recent audit indicated patient age ranges from 8 to 59 years, with the majority between 15-19 years. There is a preponderance of male patients (72 per cent), and the majority (96.7 per cent) of patients have other psychiatric comorbidities. Common comorbidities include ADHD, ASD, depression, anxiety disorder and substance use disorder. Less common comorbidities include PTSD, psychosis and bipolar disorder.
The GDC now provides outpatient care for the community in WA, accepting referrals from GPs, teachers, and non-GP specialists. It is a state-wide clinic, providing face-to-face, telephone and telehealth services for patients meeting referral criteria. We also aspire to provide primary and secondary prevention in the future when funding becomes available.
Notes on referral to the FSH GDC:
- Email referrals gamingdisorderclinic@health.wa.gov.au
- Referral criteria include patients who:
- game excessively and experience functional impairments
- are aged above 16 (but we can consider lower age range on a case-by-case basis)
- are not currently suicidal
- are currently case managed by a service or have already been referred and accepted. This includes those managed by a psychiatrist or paediatrician in hospital/community based public health services (or in the private sector on a case-by-case basis).
- Include comprehensive written referral, with medical clearance for organic illnesses if relevant
- The intervention offers digital detox, relapse prevention, psychoeducation, social prescribing, assessment and treatment of underlying conditions, as well as intervention/education for carers or parents.
References:
- Cheng, C., Cheung, M.W.L. and Wang, H.Y., 2018. Multinational comparison of internet gaming disorder and psychosocial problems versus well-being: Meta-analysis of 20 countries. Computers in Human Behavior, 88, pp.153-167.
- Le, H. K., Ortiz de Gortari, A. B., Callan, A., Poynton, D., Vecchio, D., & Chen, W. (2023). Game transfer phenomena in a clinical case with psychosis and gaming disorder. Psychiatry International, 4(3), 286-296.
Additional resources recommended by the editor:
- headspace guide for family and friends – understanding gaming
- RACGP Journal Article – Just one more level: Identifying and addressing internet gaming disorder within primary care