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Nervenheilkunde 2021; 40(01/02): 27-34
DOI: 10.1055/a-1300-7787
Schwerpunkt

Wann machen digitale Spiele krank?

Überlegungen zur Gaming Disorder im ICD-11When do digital games become a health issue?Considerations regarding the diagnosis of Gaming Disorder in ICD-11
David Mikusky∗
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
Birgit Abler∗
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
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ZUSAMMENFASSUNG

Computer-, Video- und Mobilespiele (digitale Spiele) sind ein weit verbreitetes Massenmedium, das in allen Altersklassen und sozialen Schichten vertreten ist. Damit im Zusammenhang stehende Krankheitsbilder sind im Abschnitt für Forschungsdiagnosen des Diagnostic and Statistical Manual of Mental Disorders (DSM-5) als Internet Gaming Disorder und den Vorabversionen der International Statistical Classification of Diseases and Related Health Problems (ICD-11) als Gaming Disorder definiert. In der Literatur kontrovers diskutiert wird neben der Notwendigkeit einer möglichen Überpathologisierung von Alltagsverhalten die nosologische Einordnung als Suchterkrankung versus Impulskontrollstörung. Hinweise zur Einordnung als Suchtverhalten geben zum einen Validierungsstudien der Diagnosekriterien, in welchen mit Toleranzentwicklung, Kontrollverlust und Vernachlässigung anderer Aktivitäten allgemeine Suchtkriterien zur Voraussage einer Beeinträchtigung als geeignet eingeschätzt werden. Zum anderen zeigen neurobiologische und bildgebende Befunde eine deutliche Übereinstimmung der Veränderungen bei Konsumenten digitaler Spiele mit denen, wie sie auch bei stoffgebundenen Suchterkrankungen beobachtet wurden. Hilfreich bei einer Risikoeinschätzung für die Entwicklung eines psychiatrisch relevanten Syndroms kann die Kenntnis von Spielmechaniken und Bezahlmodellen digitaler Spiele sein, welche nach lerntheoretischer Konzeption zur Entstehung beitragen können: Gestaffelter Fortschritt im Spiel (Progressionssysteme) mit an saliente Reize gekoppelte Belohnungen zur Charakteraufwertung, der Spieleinstieg ohne Bezahlung (free-to-play), Erwerb von Spielfortschritt und Individualisierungsoptionen (In-Game-Items) durch Kleinstbeträge (Mikrotransaktionen) und an Zufall gekoppelte Belohnungen mit der Möglichkeit, digitale Münzwürfe zu erwerben (Lootboxen) können die Entwicklung von Suchtverhalten fördern.

ABSTRACT

Computer, video and mobile games (digital games) are a widespread mass medium present in all age groups and social classes. Related disorders have been defined as Internet Gaming Disorder in the section for research diagnoses of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and as Gaming Disorders in the preliminary versions of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). There is controversial discussion of the necessity not only in the light of a possible over-pathologization of everyday behavior but also regarding the nosological classification as an addictive disease versus impulse control disorder. Validation studies of the diagnostic criteria provide indications for a classification as addictive behavior: The development of tolerance, loss of control and neglect of other activities are general addiction criteria and are considered suitable for predicting impairment. Also, neurobiological and imaging findings overlap with those observed in substance-bound addictions. The knowledge of game mechanics and payment models of digital games which can contribute to the development of addictive behaviors according to learning theory, can be helpful in risk assessment: Staggered progress in the game (progression systems) with rewards linked to salient stimuli for character enhancement, game entry without payment (free-to-play), acquisition of game progress and individualization options (in-game items) by means of small amounts (microtransactions) and rewards linked to chance with the possibility ofacquiring digital coin tosses (lootboxes) might facilitate the development of psychiatric conditions.

Schlüsselwörter

Digitale Spiele - Gaming Disorder - Suchterkrankung - Impulskontrollstörung - Risikoeinschätzung an hand Spielmechaniken

Key words

Digital games - gaming disorder - addictive disorder - impulse control disorder - risk assessment based on game mechanics


Publication History

Article published online:
04 February 2021

© 2021. Thieme. All rights reserved.

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