Although multiple research studies were carried out on the effects of excessive video game use, our study was carried out to investigate whether or not different attachment styles are associated with a higher use of violent video games. There is scarce literature on the association between different attachment styles and violent video games, where most studies focused on video games in general.
Our results found that 190 (48.8%) participants were classified as being highly exposed to violent video games which is a high prevalence as found in several previous studies33. This shows that this is actually a prevalent issue amongst male adolescents in Lebanon. This is alarming and can be attributed to the severe political, social, and economic situations of the country. Teenagers might be using violent gaming for coping and escape to distract themselves from daily hassles and difficult circumstances34.
The different findings of our study suggest an association between different attachment styles and engagement in violent video games. Dismissing attachment style was associated with lower violent video game use whereas fearful attachment style was associated with higher use. Studies have shown that dismissive individuals play video games in a manner similar to their actions in their daily life, spending more time alone rather than socializing 35. Hence, further studies should be done on whether their engagement in video games (even violent gaming) depends more on the genre or whether the game is an MMO (Massive Multiplayer Online gaming). These types of individuals could either be using MMOs as means to satisfy their social needs yet maintaining a barrier within that socialization, or they could be using video games that are not MMO to escape socializing altogether in their free time36.
As for individuals with a fearful attachment style, they tend to feel unworthy of support and are distrustful of others, hence they distance themselves. Their high engagement in violent video games would be their way of coping with their emotions or they could be emerging themselves in a world of their own where they escape reality and try to construct their identity through this creative platform 37.
On the contrary to our findings, a recent study in the region, carried out on 1391 children and adolescent aged 9 to 15 years, had reported no differences in violent video game involvement between the three attachment patterns (secure, insecure-avoidant, and insecure-anxious)38. This can be attributed to the fact that in many current video games, violent acts are not a choice done by players but rather are part of the rules of the game. The players need to follow the rules to play effectively and achieve optimal results. However, these games have prosocial aspects such as communication with other players, sharing, and helping, which are more self-directed and autonomous; hence, they allow more of the players' personalities to be expressed in the game.
Video games have evolved into complex interactive experiences where players can freely decide on different courses of action which can result in completely different gaming experiences39. Within the same game, referred to as violent, players can exhibit violent actions such as killing and eliminating other players, and prosocial behavior such as saving the life of other players or displaying cooperation, especially when they play together in teams or groups40. Hence, creating two separate variables, one reflecting non-violent prosocial game content and the other reflecting violent content, is better to understand the association between attachment styles and exposure to violent video games.
A higher age was correlated with a lower use of violent video games. Similar results were found in previous studies where people of lower age groups showed the most engagement with violent video games in addition to an increased time spent playing the game41. This could be due to the fact that people of lower age are still trying to determine the character that they want and online video games give them a platform to experience different characteristics and emotions42.
Implications for psychiatric nursing practice
This study highlights the importance of awareness campaigns about violent video gaming in adolescents. Gaming affects the adolescents mentally and physically. The effects are variable depending on the attachment type of the adolescents. As mental health issues are pillars in the health promotion in schools, including the effects of violence in the video games within the topics is becoming an urgency, specially that the adolescents are spending more time in front of screens, making access to violent video gaming very easy. Thus a national approach from the ministry of education would be among the best available and effective options to mandate the inclusion of emerging topics that have effects on the short and long term effects on the adolescents' well-being. It is time to consider the mental health a crucial topic among the other health components tackled in schools and media.
This project is an eye opener for all health care professionals including nursing professions dealing with mental health and wellbeing of adolescents whether be it by practice, research or education, to take into consideration the effect of violent video gaming not only on the common areas of practice like behavior, anxiety, stress and concentration among others, but also its implication on the attachment styles of the individuals. We should never forget that what the adolescents experience during their teen age will not only affect that period of life but it will definitely shape their future mental and physical health.
Limitations and strengths
The study did face several limitations as it should focus more on gender differences and the relation of gender to aggression as that might play an important role in one’s exposure to violent video games. In addition, the study did not take into account the type of violent video games – whether they’re MMOs or not – as that might have an impact on the relation as well. It is noteworthy to note that this study is a cross-sectional study and did not take into account different behaviors over a period of time, but rather the results were collected through self-questionnaire and the results are, thus, subject to information bias. Moreover, the scales used in the questionnaire are not validated. Finally, a residual confounding bias is also possible since not all factors associated with violent video games were taken into consideration in this study. However, this study was able to find an association between different attachment styles and exposure to violent video games, a topic that not only is newly studied in Lebanon, but is also scarcely investigated in the literature, which focuses on video games in general rather than violent ones. Not to mention, this study was quick and inexpensive to carry out while using multiple scales in regards to the aforementioned relations.