Sleep Deprivation and Self-Harm Associated With Excessive Gaming: A Case Report

ABSTRACT

Excessive gaming may be associated with sleep deprivation and self-harm. One active duty member committed self-injurious behavior to avoid work-related consequences. It was discovered that the patient participated in a video-gaming binge throughout an entire 72-hour weekend liberty. The patient experienced severe sleep deprivation to the point where he overslept and failed to report to work. He injured himself and fabricated a robbery and assault to avoid disciplinary consequences. Military health care providers should consider excessive gaming in patients presenting with sleep issues, self-harm, and disciplinary problems. As the prevalence of gaming increases, the military leadership should be aware that excessive gaming can degrade force readiness.

BACKGROUND

Excessive gaming shares similar characteristics with substance and gambling addictions. When online gaming for over 40 hours per week, individuals can develop psychological triggers, cravings, and addiction-seeking behaviors.^1,2 Excessive internet gaming alters neural pathways impacting the functionality of an individual’s activities of daily living.

In the military, the active duty force is responsible for maintaining individual fitness, job performance, and upholding social standards. Although no one is safe from the effects of excessive gaming, 18–25 year olds seem especially susceptible because over 96% of persons aged 18–25 own a smartphone, which is the highest percentage out of any age group.³ In 2019, the State of Online Gaming concluded that smartphones are the primary devices used for gaming.⁴ The authors additionally noticed a concerning trend that “binge-gaming” is an emerging behavioral pattern in this age group of individuals, meaning players will game for lengthy, consecutive hours in one sitting. When active duty 18–25 year olds, who make up the largest segment of the military population, participate in excessive gaming, their individual readiness is at risk due to resulting poor job performance and unpredictable behavior. As demonstrated by the case of a noncommissioned officer at Naval Air Station (NAS) Pensacola, excessive gaming can manifest in poor outcomes in otherwise healthy, competent, and well-trained individuals.

CASE DESCRIPTION

A male U.S. Marine Corps Staff Sergeant, in his late twenties and an Avionics Mechanic Instructor at NAS Pensacola, was in an Unauthorized Absence status after 72 hours of liberty. His command found him in his home with multiple hesitation chest wounds and a pneumothorax. An investigation of the home revealed over 30 knife marks on the bedroom wall, dysfunctional toilets, human waste in buckets, and trash throughout the home. Although the patient initially claimed he was robbed and assaulted, he admitted to over-sleeping his alarm after playing a massive multiplayer online role-playing game (MMORPG) to the point of severe sleep deprivation during the weekend. He fabricated the robbery and assault as an excuse for missing work and admitted to self-inflicting his injuries. He was diagnosed with adjustment disorder. No other physical or mental disorders were identified. He was administratively separated from military service by reason of the diagnosis of adjustment disorder.

DISCUSSION

Excessive gaming is prevalent in society and should be assessed by military medical providers. This case of a service member’s self-inflicted injuries serves as an example of the severity to which excessive gaming and gaming binges can affect individuals. The Staff Sergeant’s ability to function independently was compromised by his unsafe living conditions and his distorted decision-making. He reported that his unclean living conditions were due to the majority of his off-duty time being devoted to the MMORPG and that he had little time to upkeep his home. His actions of self-harm are particularly striking, as he had no prior medical conditions and to outward appearances was a reliable service member as an Avionics Mechanic Instructor. The Staff Sergeant’s behavior warrants further consideration of precipitating factors, including his excessive gaming, to better understand why this event occurred.

Excessive gaming and binge-gaming threaten discipline, sleep, and individual fitness when their appeal interferes with daily living.⁵ The pleasure and excitement associated with the online experience, such as in-game achievements, immersive environments enhanced with built-in music, and interactions with other players, stimulate the hypothalamus–pituitary–adrenal axis.^6–9 Physiologically, this causes increased heart rate, blood pressure, sympathetic tone, plasma norepinephrine, and food consumption.^6,7 Individuals will also experience less pain perception while gaming.^10,11 Ultimately, players have increased arousal and cortisol release, resulting in adverse effects on sleep, attention, and concentration (real) when too much gaming occurs.^1,10,12 CAPT Dave Kurtz, the former Executive Officer of the USS Nimitz (CVN-68), in a 2020 article in Proceedings of the U.S. Naval Institute, reported that 80% of sailors going through nonjudicial punishment had multiple write-ups for being late to work or disappearing during the duty day associated with going to bed late because of gaming, internet use, and social media.¹³

According to the World Health Organization’s 11th Revision of the International Classification of Diseases, gaming disorder is a pattern of behavior identified by impaired control over gaming leading to an increase in priority placed on gaming compared to other interests and activities of daily living. Despite negative repercussions, the gaming behavior will continue to escalate over a period of at least 12 months.¹⁴ This case report is limited due to the lack of representative sampling amongst active duty service members. Interestingly, a study of medical and nursing students at the Uniformed Services University showed that 5.5% of the participants indicated problems with internet use.¹⁵ Excessive gaming and binge-gaming are insider threats to collective military readiness beginning at the individual level. Future research is needed to determine the prevalence of sleep deprivation and poor work performance associated with excessive gaming and gaming binges. Moving forward, excessive gaming and binge-gaming should be addressed.

ACKNOWLEDGMENT

None declared.

FUNDING

None declared.

CONFLICT OF INTEREST STATEMENT

The authors have no financial conflicts of interest. A.P.D. is a volunteer lecturer on the topic of video game addiction.

REFERENCES

Author notes