MMORPG Problematic Usage / Addiction

“Massively Multiplayer Online Role-Playing Games”   Playing in Excess: Implications for Rehabilitation

Andrew M. Byrne, M.S., C.R.C.
Dept. of Rehab Studies
East Carolina University
Greenville, NC 27858

The Problem
  “You might find it alarming that one of the top reasons for college drop-outs in the U.S. is online gaming addiction—such as World of Warcraft—which is played by 11 million individuals worldwide.”

FCC Commissioner Deborah Taylor Tate, addressing the Practicing Law Institute on Telecommunications Policy and Regulation, December 5, 2008

Today’s Agenda

  1. Some history and context for the MMORPG phenomenon:

Culture, The Industry, Prevalence, Structure

  1. Problematic Use:

Selected Incidents, Selected Research

  1. Applicability to Process Addiction
  2. Implications for Rehabilitation

Proposed Research

Measurement, Impairment, and Treatment


Baby Boomers: Approximately 79 Million in the U.S., Born between 1946 to 1964

Population Reference Bureau, 2009

Generation X: Approximately 50 million in the U.S., Born between 1965 and 1976

Diane Thielfoldt and Devon Scheef, 2004

Generation Y: Approximately 78 million in the U.S., Born after 1980.

Kreyewski, K., International Affairs 2009 (1977, 1983 are also cited as the beginning of Gen Y)

MMORPG stands for massively multiplayer online role playing game, a type of MMOG (massively multiplayer online game). An MMORPG is a computer-based RPG (role playing game) which takes place in an online virtual world with hundreds or thousands of other players. In an MMORPG, a player uses a client to connect to a server, usually run by the publisher of the game, which hosts the virtual world and memorizes information about the player.

Anissimov, Michael (2007). “What is an MMORPG?”. wiseGEEK. Retrieved 9/1/2009.

MMORPG Market Shares: World of Warcraft, Developed by Blizzard Online, a division of Activision Blizzard owned by Vivendi Games is by far the most prevalent, with over 11 million players.

World of Warcraft > Hollywood:

2008’s highest grossing movie, “The Dark Knight”: $67,165,092 in 24 hrs 24 hours.

World of Warcraft’s “Wrath of the Lich King” Expansion: 2.8 million copies in 24 hours: $111,972,000

Components of World of Warcraft: Player versus Player (PVP), Player versus Environment (PVE), Personal questing & raiding, Achievements System, Economy (Auction House), Social (Guilds)

Ancillary Industries: Virtual Goods, Gold Farming

Gaming Cycle: Pressure, Suspense, Decision-making, Achievement cycle of gaming ~ Deng & Zhu, 2006

Time Management:

“Grinding”: It takes 300 hours to get a character to level 80. The average gamer plays 20 hours per week.

The Internet Addiction Test – Developed by Dr. Kimberly Young, St. Bonaventure University

Based on the DSM-IV criteria for Pathological Gambling, first validated diagnostic tool for internet addiction. The inventory is available at

Source:                 Widyanto, L & McMurren, M.. (2004). The psychometric properties of the Internet addiction test. CyberPsychology & Behavior, 7(4):445-453.

Young’s Internet Addiction Test is available from

Scoring the IAT: NORMAL RANGE 0 – 30 points; MILD 31- 49 points; MODERATE 50 -79 points; SEVERE 80 – 100 points

Selected Research:
Dr. Douglas Gentile

8 percent of gamers, according to a national study, show “addictive” gaming behavior, based on DSM criteria for pathological gambling.

Gentile, D. A. (in press). Pathological video game use among youth 8 to 18: A national study. Psychological Science.

Hauge, M. R., & Gentile, D. A. (2003, April). Video game addiction among adolescents: Associations with academic performance and aggression. Poster presented at the 2003 Society for Research in Child Development Biennial Conference, Tampa, FL.
Dr. Nick Yee

Nick Yee (Stanford University) conducted the largest, longest-running survey of online gamer behavior, later to be named The Daedalus Project.

While the Project is “in hibernation” as of 2009, over 40,000 gamers were surveyed on demographic, social, and motivational variables, including emergent social trends.

Yee, N. (2006). The Demographics, Motivations and Derived Experiences of Users of Massively-Multiuser Online Graphical Environments. PRESENCE: Teleoperators and Virtual Environments, 15, 309-329.

“The Daedalus Project” by Nick Yee, available at:

Process Addiction: An addiction to an action or routine of actions such as gambling, eating, shopping, working, or sexual activities. The addiction is not to a tangible thing – but in acquiring or participating- an addiction to the movement or process.

Behavioral Addiction: Any activity, substance, object, or behavior that has become the major focus of a person’s life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially is considered an addictive behavior.

  • Engs, R.C. (1996). Alcohol and Other Drugs: Self                 Responsibility. Bloomington, IN: Tichenor Publishing Company.

Current DSM Semantics

  • Compulsion (as in obsessive compulsive) indicates the behavior is undertaken in order to reduce anxiety or stress.
  • Impulse Control indicates “pleasurable relief”.
  • “Addiction” is still limited to “substances”.
  • Pathological Gambling

–        Diagnostic criteria for 312.31 Pathological Gambling
A. Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:

  • (1) is preoccupied with gambling
    (2) needs to gamble with increasing amounts of money in order to achieve the desired excitement
    (3) has repeated unsuccessful efforts to control, cut back, or stop gambling
    (4) is restless or irritable when attempting to cut down or stop gambling
    (5) gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
    (6) after losing money gambling, often returns another day to get even (“chasing” one’s losses)
    (7) lies to family members, therapist, or others to conceal the extent of involvement with gambling
    (8) has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling
    (9) has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
    (10) relies on others to provide money to relieve a desperate financial situation caused by gambling

–        B. The gambling behavior is not better accounted for by a Manic Episode.

C.A.G.E.  Questionaire (traditionally used for Alcohol, but adapted for other addictions)

–        Replace alcohol with game play:

C.A.G.E.  (revised for MMORPG Addiction)

  • C             Cut down Have you ever felt you should cut down on gaming?
  • A             Annoyed Have people annoyed you by criticizing your gaming?
  • G             Guilty Have you ever felt guilty about your gaming?
  • E              Eye-opener Have you ever had an ‘eye-                opener‘ – gaming the first thing in the                 morning, or after school, or after work, to help you feel better?

Diagnostic Implications:

For validated testing, the Internet Addiction Test (IAT) is available.

Consider co morbidity with other behavioral disorders and addictions.

Identifying a process addiction is based on bio-psycho-social consequences, and repeated use despite those consequences.

Compiled October, 2009

Additional Sources & Selected Readings:

American Psychiatric Association (2007, June 26). American Psychiatric Association Considers ‘Video Game Addiction’.

BBC News. (2005) China imposes online gaming curbs. Retrieved 9/14/09 from

Gentile, D. A. (in press). Pathological video game use among youth 8 to 18: A national study. Psychological Science.

Gentile, D.A. (2007) Video game addiction: is it real? Harris Interactive.
April 2.

Iowa State University (2009, April 21). Nearly 1 In 10 Youth Gamers Addicted To Video Games.

Williams, D., Ducheneaut, N., Li, X., Zhang, Y., Yee, N., Nickell, E. (2006). From Tree House to Barracks: The Social Life of Guilds in World of Warcraft. Games and Culture, 1, 338-361

Yee, N (2007). Motivations for Play in Online Games. CyberPsychology and Behavior, 9, 772-775.

Zhu, Z., & Deng, P. (2006) PS-DA Model of Game Addiction: Theoretical
Hypothesis and Case Analysis in: Technologies for E-Learning and Digital Entertainment. Volume 3942, pp.444-452.

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