Introduction

There are parents who describe their teenagers as “addicted” to video games.  They might be right. On their path to seek help for their kids who seem lost in another world, could they have their children committed to a psychiatric facility? Perhaps.

In this blog we will explore a case where a person diagnosed with Video Game Addiction was required to go to a psychiatric facility for help, as well as what it means to have a video game addiction and a new lawsuit against the creators of Fortnite.

What is Video Game Addiction?

Not all experts agree that video game addiction should qualify as a unique mental health condition. Certainly, for the overwhelming majority of people, extensive gaming does not rise to the level of addiction. It is being debated whether problematic gaming is simply a symptom of an underlying condition, as opposed to a unique condition.

Notably, the World Health Organization added “Gaming Disorder” to its 2018 International Classification of Diseases. They said:

For gaming disorder to be diagnosed, the behaviour 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.

 The American Psychiatric Association is of the view that internet gaming disorders should not be diagnosed just yet because further research is still required.  They have, however, articulated what the symptoms may be if it becomes recognized as a unique mental health disorder. To be diagnosed with an internet gaming disorder, a person would have to display 5 of the following:

• Preoccupation with gaming
• Withdrawal symptoms when gaming is taken away or not possible (sadness, anxiety, irritability)
• Tolerance, the need to spend more time gaming to satisfy the urge
• Inability to reduce playing, unsuccessful attempts to quit gaming
• Giving up other activities, loss of interest in previously enjoyed activities due     to gaming
• Continuing to game despite problems
• Deceiving family members or others about the amount of time spent on gaming
• The use of gaming to relieve negative moods, such as guilt or hopelessness
• Risk, having jeopardized or lost a job or relationship due to gaming

2019 Case Study

An 18-year-old in Ontario lived with his mother and sister. His first contact with the mental health system was when his family doctor made a referral because the teenager “began refusing to go to school and was excessively preoccupied with video gaming”. A child and adolescent psychiatrist assessed him and believed he had Video Game Addiction, along with anxiety disorder and major depressive disorder. The young man, however, did not follow her suggestion to seek services for his addiction.

Over time he began “living like a recluse”. He didn’t shower, wash his hair or brush his teeth. However, he also started to develop delusional beliefs about his sister planning to kill their mother. The daughter and mother started to fear for their safety. On one occasion he assaulted his sister, which led to police involvement. Police brought him to a psychiatric facility, as they are entitled to do in certain situations pursuant to Ontario’s Mental Health Act.

At the hospital he was “formed”, which is to say a form was completed requiring him to stay at the hospital against his wishes for up to 72 hours. Another form (known as a Form 3) was subsequently completed that required him having to stay for a longer period of time. As was his right, he challenged the Form 3 by applying to Ontario’s Consent and Capacity Board for a hearing.

A picture started to form that he may have a different, or at least additional, mental health issue than previously diagnosed -  schizophrenia. The Consent and Capacity Board was concerned that if he was released from hospital, he was likely to harm his sister. A likelihood of serious bodily harm to others is one of the criteria that can lead to a person being detained in a psychiatric facility. His status as an involuntary patient was upheld and he was required to stay at the facility. For clarity, the decision (released in July 2019) did not state specifically which video games the man was playing.

This decision became very straightforward because of his delusions combined with his aggressive behavior. Had the young man been addicted to video games but not harmed anyone, this case would have been far trickier, although it is possible for a person to become an involuntary patient even if there is no risk of causing serious bodily harm to themselves or others.

What does the law say?

Under the Mental Health Act, which is Ontario’s law that establishes when it is legal to detain a person in a psychiatric facility without their consent, no diagnoses are mentioned. Ontario’s mental health laws tend not to operate by listing specific illnesses; instead, the law is focused on what has actually happened and what is likely to happen in the future. So even if gaming addiction is not universally recognized as a diagnosis, this is not critical to the question of whether a person addicted to video games could be committed to a psychiatric facility.  

If a physician in the case described above assessed the 18-year-old and found that he had shown a “lack of competence to care for himself” AND the physician was of the opinion that the young man was suffering from “a mental disorder of a nature or quality that was likely to result in him experiencing serious physical impairment”, he may have been committed.

This phrase “serious physical impairment” is not defined in the Mental Health Act but in theory could apply to someone with Gaming Disorder. The man in the case above was so focused on playing video games that he didn’t shower, wash his hair or brush his teeth. What if, in addition to neglecting personal hygiene, he also barely ate? What if he stopped taking care of his belongings to the point his bedroom became infested with cockroaches? What if he stopped removing trash from his room and would just throw it into the hallway outside his bedroom, and allowed other items to pile up all around him? What if he was so immersed in gaming he urinated in his bedroom while playing to avoid leaving the screen? And what if he stopped taking medication for a moderately serious medical condition because he was too busy gaming to refill the prescription? In a case like that, it seems plausible that he could have been involuntarily committed to a psychiatric hospital solely for Gaming Disorder –even if there had been no risk to his sister.

Class Action Lawsuit Against Fortnite

In two cases, the addiction to video games became so severe that the families hired a Montreal law firm to sue the creators of Fortnite. It has been alleged that the creator hired psychologists to design the game to be as addictive as possible. The case has been compared to lawsuits against tobacco companies that failed to warn consumers about the risks. It appears that in October 2019 the law firm requested the court’s permission to launch the class action; according to the media, about 300 people have contacted the firm asking to join the lawsuit.

Conclusion

So where does this leave us? Much like consuming alcohol, playing video games can be a social or solo activity enjoyed in moderation. In fact, it can be more than an activity – it can be a hobby or a passion.  But in some cases, excessive consumption can involve significant impairment in personal, social or other important areas of functioning. In those cases, it may be necessary to seek professional help.