#66. Did I Have “Fishing Disorder” When I Was Eleven Years Old?

Here are some of my musings and others’ research on the problem of diagnosing “Internet Gaming Disorder."

Petre Kimberly/Flickr.

Dear friends,

In Letter #64, I briefly described six reasons why the terms “addiction” and “disorder” are harmful in understanding and treating problematic Internet use, including problematic video gaming and social media use. I listed these as (1) false analogy to substance addictions; (2) disempowering the person who has the problem; (3) stereotyping the person who has the problem; (4) implying that the behavior is causing the problem when it may be a consequence of the problem; (5) demonizing the activity and promoting bans, especially for kids; and 6) the problem of diagnosis.

Then, in Letter #65, I elaborated on the first of these reasons with evidence against the myth that these activities have effects comparable to drug addiction. Now, in this letter, I turn to the last item on the list, the problem of diagnosis. Since most of the relevant research has to do with video gaming, I will focus on that and save “addiction” to social media for a future letter.

The APA’s Proposed Definition of Internet Gaming Disorder (IGD)

Ever since the publication of the 5^th edition of their official diagnostic manual of mental disorders (DSM-5), the American Psychiatric Association (APA) has been considering adding Internet Gaming Disorder (IGD), which is their term for what others call video game addiction, into the next edition. On a trial basis, the APA has proposed that a person receive the diagnosis of Internet Gaming Disorder if at least five of the following nine characteristics apply to that person:

• Preoccupation*: Spends lots of time thinking about games, even when not playing them.

• Withdrawal: Feels restless when unable to play games.

• Tolerance*: Needs to play more, or play more powerful games, to get the same excitement as before.

• Reduce: Feels he or she should play less but is unable to.

• Give up other activities*: Reduces participation in other recreational activities.

• Continue despite problems: Continues to play games despite knowing that they have a negative impact on his or her life.

• Deceive*: Lies about how much he or she games.

• Escape mood*: Plays games to reduce anxiety or stress.

• Risk: Risks loss of significant relationships or employment because of games.

Just from reading this list, you can perhaps see why this definition is controversial. The proposal is that if any five of these nine characteristics apply to a person, then that person has IGD. But think about it. In the list above I placed asterisks after five characteristics that might well apply to anyone who is intensely interested in any hobby. I’m going to apply those five here to my 11-year-old self when I was deeply, one might even say obsessively, into fishing.

My Fishing Disorder (FD)

Here are the five:

Preoccupation may just mean that the person is really into it. Anyone who has a passionate interest in any hobby is likely to “spend a lot of time thinking about” it. When I was 11, I spent huge amounts of time thinking about fishing even when not doing it, and I regularly dreamed about it at night.

Tolerance likewise applies to almost any hobby. As you develop increased ability at anything, you need to increase the level of challenge to get the same thrill you got before. As time went on in my childhood fishing career, I needed to catch bigger fish, or more difficult-to-catch varieties, to get the same thrill that I had previously felt from catching little perch and sunfish.

Give up other activities. Well, of course, whenever you spend more time on any hobby there is less time for other things. Time is finite, so there’s always a tradeoff. One whole summer I almost completely gave up baseball and neglected some of my home chores for the sake of fishing. And, yes, time management is important (see Letter #64).

Deceive. In a world where others disapprove of video gaming and are continuously nagging the gamer to play less, it is hardly surprising that some would lie about how much they play. I’m not sure if I ever lied about fishing as a kid, but if people then had disapproved of fishing as people now disapprove of playing video games, I probably would have lied, and I might also have felt ashamed of my fishing hobby. It is possible that I did lie once or twice, when I skipped part of a school day to extend an early-morning before-school fishing adventure. For the sake of this discussion, let’s say I did.

Escape mood. Don’t we all sometimes, if not often, engage in our favorite hobby as a way of reducing anxiety or stress? If the hobby were reading, or chess, or bicycling, people might regard this as a plus, not a minus. Yes, at age 11, I sometimes went fishing to escape the arguments and stress at home. In Minnesota, where I lived at that time, it was quite common for people to recommend fishing as therapy. Someone would say to someone suffering from anxiety, “What you need to do is go fishing.”

So, if Fishing Disorder had been a diagnostic category when I was a kid, I might well have been diagnosed as having this mental disorder.

Research on IGD Prevalence and Validity

Given the vagaries of the defining criteria, it is not surprising that different researchers have reported a rather wide range of prevalence of IGD—most often somewhere between 0.6% and 6.0% of gamers (Markey & Ferguson, 2017). Such research indicates that, no matter how the diagnostic criteria are interpreted, the great majority of gamers, including most who spend great amounts of time on it, are not “addicted.” To be truly immersed in a hobby is not a disorder.

Moreover, the research suggests that even most people who meet the diagnostic criteria for IGD are not, by their own reports, suffering from their gaming, just as I was not suffering from my FD at age 11. In a set of large international surveys, involving thousands of gamers, using the APA diagnostic criteria, Andrew Przybylski and his colleagues (2017) found that 2.4% of gamers endorsed at least 5 of the 9 criteria, and thereby met the diagnostic criteria for IDG. However, only about a third of that 2.4% responded yes to a question about whether gaming was a significant source of distress to them. So, if we were to define IDG as meeting the APA diagnostic criteria and feeling distressed about their gaming, the percentage would be brought down to less than 1%.

In a society where approximately 30% of young people suffer from anxiety or depression, it is not surprising that approximately 30% of young people who meet the diagnostic criteria for IDG suffer from anxiety or depression. There is little or no evidence that their anxiety or depression is caused by problematic gaming. Longitudinal studies, in which video gamers are assessed for IDG and for emotional disorders at two or more points in time, commonly reveal that the emotional disorders precede, rather than follow, periods of elevated gaming (Etchells, 2024; Ferguson et al., 2023). Stated differently, anxiety or depression leads to more gaming, but more gaming does not lead to anxiety or depression. Indeed, some studies have shown that gaming reduces anxiety and depression.

Such findings have led some researchers (e.g. Hygen, 2020: Jeong et al., 2024) to suggest that video gaming may be good therapy, much as my fellow Minnesotans thought fishing was good therapy. Gaming and fishing (like so many other enjoyable hobbies) keep you from ruminating about your problems and, in the case of multiplayer gaming or group fishing, connect you with others and reduce loneliness. And the joy of raising your level in a challenging game or catching a 5 pound bass immediately lifts your spirits.

Hey, if you are feeling down, take up fishing or video gaming or some other hobby you can really get into.

Of course, I must admit that the non-starred items on the APA diagnostic list are real problems. If someone is restless when not able to play, is losing significant relationships or meaningful employment because of gaming, and/or feels that gaming is causing more harm than benefit yet is unable to stop, then that person has a problem. But problematic gaming at this level is very rare, including fewer than 1% of gamers.

Longitudinal research as well as clinical interviews indicate that problematic gaming at this level is more often caused by serious pre-existing emotional problems than a cause of such problems. You can easily imagine why that might be so. A person too depressed or anxious to leave the house, for example, might turn to video games for at least some relief. I described some clinical examples of that some years ago here. You are not going to cure the emotional problem by taking the video game away. If you want to help the person you must help them identify whatever it is that is making them depressed or anxious in the first place and help them deal with that. Sometimes that is the job of a good therapist.

Further Thoughts

Video gaming grabs and holds people because it is challenging and rewarding. It is, as psychologist Mike Langlois points out, “hard fun.” It builds the brain. In an era when we offer children so few ways to satisfy the three basic psychological needs—for autonomy, competence, and connectedness to peers—video games provide a way. I may discuss that in a future letter.

Please feel free to comment, below. Your questions, thoughts, stories, and opinions are valued and treated respectfully by me and other readers, regardless of the degree to which we agree or disagree. Readers’ comments add to the value of these letters for everyone.

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Note Concerning Periodic Live Online Meetings for Paid Subscribers

I described the plan for online meetings in my previous (unnumbered) letter here. In response to that, and to the letter before that, two or three readers said they would love to join such meetings but truly can’t afford the $50 paid membership fee. At least one or two generous readers said they would be willing to gift a subscription to someone who is strongly motivated to attend the online meetings but can’t afford a subscription.

So here is what I have done. I have created a Google Doc where people who are willing to offer a gift subscription can put their name and email address. By accessing the Google Doc, anyone looking for such a gift can—if a potential giver is listed there—email that person and make their request by private email—no need to make it publicly on the Google Doc or even to say who you are.

Here is the link to the Google Doc: https://docs.google.com/document/d/1hfyekoZEOafLhcgnYhgcIglEgZw6fCNfJuwz2stYwJQ/edit?usp=sharing

The first of these online meetings will be on Saturday, February 22, at 2:00 Eastern Time. At this meeting I will describe briefly the history of changes in U.S. teens’ mental wellbeing over the past 70 years and my theory of societal causes of those changes. Then I will open the meeting up for questions and discussion. This coming Saturday, Feb. 15, I will post a substack letter to paid subscribers only explaining how to register for that meeting. So, if you are not a paid subscriber and would like to attend that meeting, now is the time to upgrade your subscription.

With respect and best wishes,

Peter

References

Etchells, P. (2024). Unlocked: The real science of screen time (and how to spend it better). London: Little Brown.

Ferguson, C.J., Jeong, E.J., & Wang, J.C.K. (2023). Pathological gaming: a longitudinal study from the perspectives of mental health problems and social stress model. The Journal of General Psychology 150, 323–343.

Hygen, B.W. et al. (2020). The co-occurrence between symptoms of internetgaming disorder and psychiatric disorders inchildhood and adolescence: prospective relations orcommon causes? Journal of Child Psychology and Psychiatry 61, 890–898

Jeong, H., et al (2024). Association Between Mental Health Problems and Internet Gaming Disorder Using Clinical Diagnostic Interviews: A Two‑Year School‑Based Longitudinal Study, International Journal of Mental Health and Addiction https://doi.org/10.1007/s11469-024-01380-3

Markey, P.M., & Ferguson, C.J. (2017). Moral combat: why the war on violent video games is wrong. Dallas: BenBella Books.

Przybylski, AK, Weinstein, N, Murayama, K: Internet gaming dis- order: investigating the clinical relevance of a new phenomenon. Am J Psychiatry 174, 230–236