Participants
17 adolescents were recruited between April 2018 and March 2019 in south-west France (see Table 1). Seven of the adolescents contacted declined to take part in the study, without providing any reason.
The adolescents recruited were aged between 10 and 18; the average age was 14.2. The sample comprised 4 girls and 13 boys, all in school; two were non-gamers. Three adolescents had been taken to see a health care professional regarding their gaming habits, which their parents saw as problematic.
Table 1: Characteristics of the sample of adolescents interviewed in 2018-2019 to explore the perception of pathological video game use.
|
Age
|
Gender
|
Schooling*
|
Medical attention linked to video games
|
Media
|
Game mode
Online or offline
|
Game mode
Single or multiplayer
|
Type of game**
|
Time playing***
(hours/day)
|
Parental Control
|
Family Structure
|
Siblings
|
Parent Professions****
|
Interview 1
|
16
|
Male
|
Year 12, Science
|
No
|
PC – Console
|
Online and offline
|
Single and multiplayer
|
Adventure – Shooting
|
Weekly
W/d: 0h W/e: 4h
|
No
|
Biparental
|
4
|
3 - 3
|
Interview 2
|
12
|
Male
|
Year 7
|
No
|
PC – Console
Tablet – Smartphone
|
Online
Offline
|
Single
Multiplayer
|
Adventure – Shooting
Strategy
|
Daily
W/d: 1h W/e: 5h
|
No
|
Biparental
|
2
|
5 - 6
|
Interview 3
|
15
|
Male
|
Year 11
|
No
|
PC – Console
|
Online
Offline
|
Single
Multiplayer
|
Adventure –
Combat
|
Daily
W/d: 3hW/e: 5h
|
Yes
|
Biparental
|
4
|
3 - 5
|
Interview 4
|
17
|
Male
|
Technical Tertiary Studies
|
Yes
|
Console – Tablet
|
Online
Offline
|
Single
Multiplayer
|
Adventure – Combat
|
Daily
W/d: 2.5h W/e: 3.5
|
Yes
|
Biparental
|
4
|
3 - 5
|
Interview 5
|
11
|
Male
|
Year 6
|
No
|
Console – Tablet
|
Offline
|
Single
Multiplayer
|
Adventure – Sport
|
Daily
W/d: 45min W/e: 45min
|
Yes
|
Biparental
|
4
|
3 - 5
|
Interview 6
|
15
|
Female
|
Year 11
|
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Biparental
|
2
|
3 - 3
|
Interview 7
|
16
|
Female
|
Year 13, Science
|
No
|
PC – Console – Smartphone
|
Offline
|
Single
Multiplayer
|
Management – Platform
Edutainment
|
Weekly
W/d: 4hW/e: 0h
|
Yes
|
Biparental
|
2
|
3 - 3
|
Interview 8
|
14
|
Male
|
Year 10
|
Yes
|
Console
|
Online
|
Multiplayer
|
Shooting – Sport
|
Weekly
W/d: 5h W/e: 5h
|
Yes
|
Single parent
Divorce
|
3
|
2 - 6
|
Interview 9
|
13
|
Male
|
Year 10
|
No
|
Console
|
Online
|
Multiplayer
|
Shooting – Sport
|
Daily
W/d: 2h W/e: 8h
|
Yes
|
Biparental
|
2
|
4 - 4
|
Interview 10
|
18
|
Male
|
Year 13, STAV
|
No
|
PC – Smartphone
|
Online
Offline
|
Single
Multiplayer
|
MOBA – Shooting
|
Weekly
W/d: 0h W/e: 8h
|
No
|
Biparental
|
2
|
7 - 7
|
Interview 11
|
17
|
Male
|
Year 13, ES
|
No
|
Console – Smartphone
|
Offline
|
Multiplayer
|
Adventure
|
Occasional
|
No
|
Blended
Divorce
|
3
|
3 - 4
|
Interview 12
|
13
|
Female
|
Year 9
|
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Biparental
|
3
|
4 - 4
|
Interview 13
|
13
|
Male
|
Year 9
|
No
|
Console – Tablet – Smartphone
|
Online
Offline
|
Single
Multiplayer
|
Shooting
|
Monthly
|
No
|
Biparental
|
2
|
3 - 4
|
Interview 14
|
14
|
Male
|
Year 10
|
No
|
Console – Tablet
|
Offline
|
Multiplayer
|
Adventure – Role Playing
|
Weekly
W/d: 0h W/e: 1 to 10h
|
Yes
|
Single parent
Divorce
|
2
|
4 - 5
|
Interview 15
|
10
|
Male
|
Year 6
|
No
|
Console – Tablet
|
Online
Offline
|
Single
Multiplayer
|
Role Playing
|
Weekly
W/d: 0h W/e: 1.5h
|
Yes
|
Single parent
Divorce
|
2
|
4 - 5
|
Interview 16
|
14
|
Male
|
Year 10
|
Yes
|
PC – Console
Tablet – Smartphone
|
Online
Offline
|
Single
Multiplayer
|
Adventure – Role Playing
Platform
|
Daily
W/d: 3hW/e: 7h
|
Yes
|
Single parent
Divorce
|
2
|
4 - 4
|
Interview 17
|
14
|
Female
|
Year 10
|
No
|
Console
|
Online
Offline
|
Single
Multiplayer
|
Shooting
|
Daily
W/d: 0-3h W/e: 5h
|
No
|
Biparental
|
4
|
5 - 8
|
* S: Scientific; BTS: Superior Technician Certificate; STAV: Agronomy Sciences and Technology; ES: Economics and Social Sciences
|
** MOBA: Multiplayer Online Battle Arena (Typology of video games)
|
|
|
|
*** W/d: Weekday W/e: Weekend Weekly: Playing video games at least once a week, but not daily
|
|
**** Socio-professional categories using French nomenclature:
|
|
|
|
|
1 : Farmers, 2 : Artisans, retailers, and business leaders, 3 : Managers and higher intellectual professions, 4 : Intermediate professions,
5: Employees, 6 : Manual workers, 7 : Retirees, 8: Other people without professional activity
The interviews lasted between 20 and 103 minutes and the average duration was 42 minutes and 15 seconds.
The analysis of these 17 interviews generated four major themes:
- adolescents’ descriptions of pathological video games use,
- the effects of video games on health,
- precipitating factors in the transition from recreational to pathological use,
- protective factors in the transition from recreational to pathological use.
Pathological video games use and its characteristics
Adolescents recognised the concept of pathological use of video games. These characteristics, as defined the adolescents, were: significant playing time, neglecting the real world, confusion between the virtual world and the real world, and symptoms similar to those linked to substance use.
Significant playing time
Significant playing time and daily gaming were the determining elements of this pathological use. The adolescents used the term ‘too much’ to describe an excessive and harmful habit in which one loses control of one’s gaming habit and has difficulty stopping. Significant playing time fostered a dangerous identification with the characters.
‘If you play for too long too often (...) it’s a sure thing that you’re going to have serious problems.’ Interview 2.
Neglecting the real world and confusion with the virtual world
The game became the dominant activity in the life of the gamer, impoverishing his or her other activities. Friends and families were ignored, and the obligations of daily life neglected. The adolescents referred to social isolation in the real world contrasted with a rich virtual social life.
‘In your bubble (...) you only think (...) about video games (...) you don’t pay attention to what’s around you’ Interview 14.
Gamers with pathological playing habits confused the real and virtual worlds. Therefore, they could transpose actions from the virtual into the real world, risking violent acts or sexually dysfunctional behaviours. This confusion was enhanced by isolation, the gamer having a poor understanding of the real world. The realistic nature of a game also facilitated this confusion.
Similarities in their discussions with issues of substance abuse
For the adolescents, pathological video games use shared symptomatic similarities with issues linked to substance abuse, which was thought to be more dangerous.
The gamer could no longer do without video games. This loss of control of the freedom to consume manifested in withdrawal symptoms, tolerance, and cravings. Significant in-game purchases could then be made.
‘It’s addictive; the more you play, the more you want to play’ Interview 7.
The effects of video games on health
The adolescents envisaged benefits as well as risks to their health from their gaming habits. The risks arose from abnormal and often excessive use. Pathological use could have consequences on physical health: eyesight, osteo-articular, and metabolic issues; and on mental health by impacting self-esteem, mood, and social relationships.
‘There is obviously an impact on our life, either positive or negative’ Interview 3.
Mood disturbance: the impact on self-esteem and social relationships
Loosing, or peer judgement of their performance, was a source of frustration, anger, and sadness. Sometimes irritability was uncontrollable, which could be a source of lowered self-worth and social isolation.
‘I am him, if he is rubbish, then so am I’ Interview 10.
Identity issues
By trying to imitate an idolised character, the gamer loses his or her personality and individuality and appropriates the shortcomings of his or her avatar. The danger resides in the identification with ‘bad characters’ and the risk of committing regrettable acts (violence, substance abuse). This led to social isolation which was considered a danger.
‘That prevents us from showing who we really are (...) we imitate a character’ Interview 3.
Family conflict
Video games caused intra-family conflicts. Competition and restrictive parental controls exacerbated the conflict.
‘I was in a fairly addictive phase (...) so there were problems between my parents and me’ Interview 4.
Risk factors in the transition to a pathological use of video games
Type of game
The type of game was blamed, especially war games, action games, MMORPG (Massively Multiplayer Online Role-Playing Game), and games with the most social and competitive elements. Portable devices (console, smartphone) that enable gamers to play were identified as a risk factor for pathological use. The omnipresence of video games in contemporary society (advertising, special events) was thought to encourage gaming.
Adolescent’s issues with social relationships
Introverted subjects appeared to be at greater risk. Their challenges with social integration in the real world explained their investment in the virtual world. Certain gamers’ motivations were linked to pathological use: competition, performance, and seeking out wellbeing.
‘They’ve got problems in their life, so they take refuge in games to be able to feel better’ Interview 16.
A deleterious family and social environment
A complex family structure (divorce, death of a parent, intra-family conflict) was associated with pathological use. An environment without friends or in an isolated location was compensated by a great investment in the virtual world.
Protective factors in the transition to pathological video games use
Protective tools specific to video games
According to the respondents, adopting systems to manage the amount of time spent gaming reduced the risk of pathological use. Complying with PEGI (Pan European Game Information) could avoid problematic use. Some of the adolescents suggested choosing less addictive games.
‘The console must shut down automatically (...) you should have to wait some time before turning it back on’ Interview 10.
Self-control by adolescents
The adolescents agreed on the need to regulate their habit. An adolescent must be conscious of the risks linked to pathological video game use. ‘Self-imposed limits’ Interview 6.
A protective family and social environment
The main protective factor referred to was parental control, which should be seen as a support mechanism that changes with the maturity of the adolescent and enables the adolescent to attain self-control based on dialogue and trust. Restrictive measures were worked around.
‘Parents are there to support you but also after a while you have to find out by yourself and, in the end, learn from your own mistakes.’ Interview 11.
Outings and non-digital activities also helped limit gaming and the risk of a pathological video games use.