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  • Become a psychiatrist

    Become a psychiatrist

    • Choose Psychiatry

      Choose Psychiatry

      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
      • Choose Psychiatry: Guidance for Medical Schools
    • Sixth formers and school students
    • Medical students

      Medical students

      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry Conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors

      Foundation doctors

      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry

      Help us promote psychiatry

      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
      • RCPsych Recruitment Strategy 2022-2027
    • Supporting Medical Students: Medical Schools
    • Careers past events
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
      • Choose Psychiatry: Guidance for Medical Schools
    • Sixth formers and school students
    • Medical students
      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry Conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors
      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry
      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
      • RCPsych Recruitment Strategy 2022-2027
    • Supporting Medical Students: Medical Schools
    • Careers past events
  • Training

    Training

    • Curricula and guidance

      Curricula and guidance

      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
      • Assessment Strategy Review
    • Your training

      Your training

      • Psychiatric Trainees' Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
      • Industrial action FAQs
      • Distribution of medical training posts
    • Exams

      Exams

      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
    • Neuroscience in training

      Neuroscience in training

      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates

      International Medical Graduates

      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry

      Building Capacity in Perinatal Psychiatry

      • Perinatal 2023 Masterclass Programme application and process details
      • Perinatal Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
      • Perinatal Psychiatry Masterclass for SAS Doctor resources
    • Dean's annual update
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
      • Assessment Strategy Review
    • Your training
      • Psychiatric Trainees' Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
      • Industrial action FAQs
      • Distribution of medical training posts
    • Exams
      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
    • Neuroscience in training
      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates
      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry
      • Perinatal 2023 Masterclass Programme application and process details
      • Perinatal Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
      • Perinatal Psychiatry Masterclass for SAS Doctor resources
    • Dean's annual update
  • Members

    Members

    • Workforce Wellbeing Hub

      Workforce Wellbeing Hub

      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development

      Supporting your professional development

      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
    • CPD eLearning
    • Submitting your CPD

      Submitting your CPD

      • Alterations to CPD during coronavirus pandemic
    • Membership

      Membership

      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties

      Your Faculties

      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Specialist and Associate Specialty Doctors

      Specialist and Associate Specialty Doctors

      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • Devolved Nations

      Devolved Nations

      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions

      English Divisions

      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups

      Special Interest Groups

      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • President's lectures

      President's lectures

      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • Obituaries

      Obituaries

      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • 2021 membership survey
    • Mindmasters quiz

      Mindmasters quiz

      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
    • Workforce Wellbeing Hub
      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development
      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
    • CPD eLearning
    • Submitting your CPD
      • Alterations to CPD during coronavirus pandemic
    • Membership
      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties
      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Specialist and Associate Specialty Doctors
      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • Devolved Nations
      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions
      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups
      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • President's lectures
      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • Obituaries
      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • 2021 membership survey
    • Mindmasters quiz
      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
  • Events

    Events

    • Conferences and training events

      Conferences and training events

      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
      • Grand Rounds
    • International Congress 2022

      International Congress 2022

      • Congress 2022 FAQs
      • Congress Webinar Package
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023

      International Congress 2023

      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Programme
      • Social Media
      • Your guide to Congress
      • Social and Fringe Events
    • In-house training

      In-house training

      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars

      Free webinars

      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
    • Conferences and training events
      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
      • Grand Rounds
    • International Congress 2022
      • Congress 2022 FAQs
      • Congress Webinar Package
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023
      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Programme
      • Social Media
      • Your guide to Congress
      • Social and Fringe Events
    • In-house training
      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars
      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
  • Improving care

    Improving care

    • College Centre for Quality Improvement (CCQI)

      College Centre for Quality Improvement (CCQI)

      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy

      Campaigning for better mental health policy

      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce

      Planning the psychiatric workforce

      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre

      Public Mental Health Implementation Centre

      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
    • National Collaborating Centre for Mental Health

      National Collaborating Centre for Mental Health

      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • Physician Associates

      Physician Associates

      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health

      Sustainability and mental health

      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • Using quality improvement
    • Net Zero Mental Health Care Research, Resources and Education

      Net Zero Mental Health Care Research, Resources and Education

      • Net Zero Mental Health Care Call for Evidence
    • College Centre for Quality Improvement (CCQI)
      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy
      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce
      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre
      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
    • National Collaborating Centre for Mental Health
      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • Physician Associates
      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health
      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • Using quality improvement
    • Net Zero Mental Health Care Research, Resources and Education
      • Net Zero Mental Health Care Call for Evidence
  • Mental health

    Mental health

    • Problems and disorders

      Problems and disorders

      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness and mental health
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • Support, care and treatment

      Support, care and treatment

      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • Valproate in women and girls who could get pregnant
      • What to expect of your psychiatrist in the UK
      • COVID-19: Medication for mental health
      • COVID-19: Remote consultations
      • COVID-19: Going to hospital for a physical illness or injury
      • COVID-19: Eating disorders
      • COVID-19: Perinatal care
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • Young people's mental health
    • Translations

      Translations

      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική γλώσσα
      • Gujurati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian italiano
      • Japanese 日本語
      • Lithuanian Lietuvių kalba
      • Pashto پښتو
      • Persian (Farsi) فارسی
      • Polish Polski
      • Punjabi ਪੰਜਾਬੀ
      • Romanian Română
      • Russian Pусский
      • Somali
      • Spanish Español
      • Turkish
      • Tamil தமிழ்
      • Urdu اردو
      • Welsh Cymraeg
      • Sindhi سنڌي
      • Ukrainian украї́нська
      • Swahili Kiswahili
      • Kurdish Kurdî
    • Mental health and psychiatry FAQs
    • Order mental health leaflets
    • About our mental health information
    • Disclaimer about our mental health information
    • Choosing Wisely - a national campaign
    • BSL translations
    • MindEd – free mental health eLearning
    • Order mental health packs for schools

      Order mental health packs for schools

      • Order form for mental health factsheets for young people
    • Audio resources
    • Veterans' mental health
    • Suicide resources
    • Problems and disorders
      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness and mental health
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • Support, care and treatment
      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • Valproate in women and girls who could get pregnant
      • What to expect of your psychiatrist in the UK
      • COVID-19: Medication for mental health
      • COVID-19: Remote consultations
      • COVID-19: Going to hospital for a physical illness or injury
      • COVID-19: Eating disorders
      • COVID-19: Perinatal care
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • Young people's mental health
    • Translations
      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Deutsch
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Gaming disorder and tips for parents: an interview with Professor Mark Griffiths

Cultural blog, Gaming the mind

23 October, 2019

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In May 2019, the World Health Organisation (WHO) agreed to recognise gaming disorder as a mental health diagnosis and confirmed its place in the new behavioural addictions section of the International Classification of Diseases 11th edition (ICD-11), which is expected to come into effect in 2022. Considering this development and the continued public debate surrounding the impact of video games on mental health, we decided it was time to revisit the topic. We spoke to Professor Mark Griffiths to get his perspective on the disorder and to explore his thoughts on the elements within games that may lead to problematic playing behaviour.

Person playing computer game

Professor Griffiths is a Professor of Behavioural Addictions and Director of the International Gaming Research Unit at Nottingham Trent University. He has been publishing research on the psychological and mental health impacts of video games since the early 90s and positions himself somewhere between the two more entrenched camps who have been vocal in the debate on gaming disorder: those who view problematic gaming as an urgent public health concern and those who urged the WHO to wait until more research was undertaken (Müller and Wölfling, 2017; van Rooij, et al., 2018). In addition to his academic work, Griffiths professes to having been a big fan of Tetris, to the point of re-experiencing the music and visuals of the game when trying to sleep, a phenomenon which has been dubbed the "Tetris Effect" (Strickgold et al., 2000). He is also a father of teenagers who regularly play games. In this interview, he offers novel ideas on the disorder, provides tips for parents, discusses his proposed diagnostic criteria and finally speaks to how games compel players to keep playing.

Griffiths is a member of the WHO committee on gaming disorder and contributed to the decision to classify gaming disorder as a mental health condition. Though not a clinician himself, he has been involved in setting up clinical services for gaming disorder in Spain based on psychological treatment approaches in Spain. He takes the opinion that if a single case of a disorder can be demonstrated to exist, this should be enough for its recognition. But regardless, he feels that there is plenty of evidence to justify recognition of the disorder. He does, however, believe that true cases are few and far between, which puts him at odds with some of his more pro-disorder contemporaries, who he says accuse him of minimising the issue. He suggests that if the prevalence was as high as even 1 or 2%, there would be far more demand for assessment and treatment than there currently is, as every school and community would feature many cases. Furthermore, he points out the average age of a gamer is now 29-31, yet very few adults seek help for gaming related problems, despite having grown up playing video games.

Not only does he see the prevalence of gaming disorder as being less than 1%, he also has his own proposed criteria for diagnosis, which are arguably more stringent than those in the ICD-11. He is mindful of the risk of over-diagnosis and believes many parents pathologise their children's gaming simply because they find it concerning if their children play games for 3-4 hours a day. Griffiths goes on to suggest that, in his experience, over-diagnosis is particularly problematic in South East Asia, specifically in South Korea, where some clinicians and policy makers claim gaming disorder prevalence rates are much higher, and where 'boot camp'-like treatment centres are far more common. In the UK, he sees a generation gap, with older adults who are unfamiliar with gaming more likely to pathologise gaming in their children.

Defining the disorder

Before we discuss Griffiths' criteria for diagnosis, it is worth revisiting the ICD-11 gaming disorder criteria, which are: impaired control over gaming, increasing priority given to gaming to the extent that gaming takes precedence over other life interests, and continuation or escalation of gaming despite negative consequences. The problem should be present for at least 12-months duration, though this time criterion doesn't need to be met if the impacts are sufficiently severe. Long before the WHO's ICD-11 decision, back in 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was published and included a provisional diagnosis of 'Internet Gaming disorder' (IGD) as a condition for further research. Whilst it shares similarities to the ICD-11 criteria, it additionally includes symptom criteria of preoccupation, withdrawal, tolerance, deception and mood modulation, for a total of nine symptoms, of which five were required to meet the provisional diagnosis (Pontes et al., 2014).

Griffiths suggests that the DSM-5 criteria are stricter than the ICD-11's, and his own criteria seem to sit somewhere between the two. He has six key criteria that must be met in order to diagnose gaming disorder: salience (total preoccupation with gaming), mood modification (using games to improve negative mood states), tolerance, withdrawal, conflict (the gaming behaviour compromises relationships at work, school, etc), and intrapsychic conflict (being unable to cut down, loss of control, relapse and guilt). He would apply the same criteria to other disordered behaviours involving exercise, sex, or even work, but again he stresses that the true number of people meeting all criteria for such a diagnosis should be very small. He believes his diagnostic criterion of 'tolerance' is the most challenging to define, because even heavy, regular play can be completely normal. He sees 'withdrawal' as being critical to the diagnosis, as a hallmark of addiction. As evidence that withdrawal symptoms occur, he notes case reports suggesting people with disordered gaming behaviour can experience increased moodiness, irritability and anxiety, and physical symptoms of hand sweats and stomach cramps, when they stop gaming.

Griffiths acknowledges the importance of allowing clinicians some flexibility regarding the required duration of the symptoms, to prevent severe cases from being excluded purely on basis of short duration. He thinks it's unlikely that anyone who has played a game intensely for a month or two would be given a diagnosis of gaming disorder, as this sort of behaviour is typical for people enjoying a game. Though he resists stipulating an arbitrary cut-off for abnormal period of intense play, he sees a duration of around 3 months being a likely minimum to indicate consideration in clinical practice.

Perhaps controversially for some, he thinks that a child or adult playing games or using social media for 3-4 hours a day is normal, and suggests four questions parents should ask of a child who plays a lot of games to assess for potential harms: are they doing their school work and homework? Are they engaged in physical activity? Do they have a wide range of peer friendships? Do they do the chores you want them to do around the house? If a parent can genuinely answer yes to these four questions, Griffiths believes they should not be overly concerned.

He feels it's critical that clinicians use a holistic approach when assessing problematic gaming. For example, such behaviour may be symptomatic of an underlying relationship problem, where gaming is used as a means to avoid conflict or confrontation. He suggests that a functional analysis type approach, i.e. one that looks at all the factors within a person's life that may drive or potentially diminish a behaviour, may help explain and treat problematic gaming. He also highlights that there is no clinically valid diagnostic instrument available for gaming disorder and diagnosis should occur only after a clinical assessment by appropriately trained clinical psychologists or psychiatrists. He also stresses that while gaming disorder may be comorbid with other psychiatric conditions such as depression, the occurrence of co-morbid conditions shouldn't preclude the diagnosis and treatment of gaming disorder.

The root of the problem

If we accept that a minority of people can develop disordered behaviour with video games, we should consider what parts of a game may lead to a loss of control over play. Griffiths believes that there are many potential elements within games that are worth considering. In a paper he co-authored with Daniel King and Paul Delfrabbro (King et al., 2010), five categories of structural features in games were proposed to influence gaming behaviour: the social aspects, such as being a member of a guild or clan; control features, such as when a player can save their progress in a game; narrative and identity features, such as avatar creation and role playing; presentation features, such as exciting and pleasing visuals; and reward and punishment features, like winning in-game currency at the end of a mission or losing potential gains if a mission is lost. Ultimately, Griffiths views gaming disorder through a behaviourist lens. Originally informed by the ideas of B.F. Skinner, behaviourists see operant conditioning, i.e. increasing the likelihood of a behaviour or response being repeated by administering rewards or punishments, as being the core feature of behavioural addiction, and therefore, of gaming disorder.

King et al. (2010) list several features in games that use operant conditioning, such as the reward of experience points (XP) after completing tasks, which can be used to level up the player's character. As increasingly more XP is needed for each subsequent level, the reward of levelling occurs on a variable ratio reinforcement schedule.

Loot boxes are probably the most controversial element in games that exploit operant conditioning techniques. For the uninitiated, loot boxes contain chance items that are either awarded directly to the player in-game or can be purchased with either real-world or in-game currency. Typically, the loot box has the appearance of a treasure chest with a hidden item. The act of opening the loot box allows the player to reveal the contents which may include items of value. More valuable items tend to be rarer. It is typically not possible to predict the number of boxes that will need to be opened to receive a desirable item. So, loot boxes offer a reward at a variable ratio schedule, like a fruit machine or a scratch card, and in common with those gambling games the reward is often presented in a visually stimulating fashion. In the operant conditioning field, this is type of reward is thought to lead to a higher likelihood of the response (opening a loot box) being repeated. The vast majority of players don't buy loot boxes at all, but an extreme minority can be compelled to spend thousands of pounds on them.

It is worth noting that the vast majority of games do not contain loot boxes and there are limitations to operant conditioning models of addiction which have been criticised for failing to consider the protective factors that exist in a human's real-world environment, such as family, friends and other commitments such as school, work or other social activities (Eitan et al., 2017; Venniro et al., 2018). There's evidence that people with high levels of psychological needs satisfaction in their daily lives are less likely to develop symptoms of disordered gaming (Weinstein et al., 2017), which suggests those most at risk may lack basic psychosocial supports in real life.

In some countries such as Belgium and the Netherlands, loot boxes have been banned from games over fears that such elements constitute gambling. The UK Parliament's Digital, Culture, Media and Sport select committee recently published their report on "Immersive and Addictive Technologies" which also recommended that loot boxes should be removed from games aimed at children. Griffiths agrees that loot boxes are akin to gambling and he has advised the Gambling Commission that loot boxes should be regulated as any other form of gambling would be.

Finally, I brought up the prospect of gaming companies using in-game algorithms and user information to manipulate player behaviour, in particular because Electronic Arts (EA), who publish major titles such as FIFA and Battlefield, recently denied the use of 'Dynamic Difficulty Adjustment' (DDA), which was reported to be a technique that allows a game's difficulty to be changed on-the-fly to encourage the player to keep playing, based on the player's performance. Such techniques may simply be a way of improving in-game experience by adjusting difficulty when a player is struggling, but as DDA had the stated aim of "maximising a player's engagement throughout the entire game" (Eurogamer, 2019), many gamers voiced concerns online that DDA and similar techniques could become problematic for people struggling to control their gaming behaviour or in-game spending. Griffiths believes there is evidence for the use of similar algorithms within the gambling industry and he wouldn't be surprised if such elements were being used in games, but this is not something he has studied, yet.

This thought-provoking discussion highlights many issues for clinicians, academics, policy makers, the games industry and the public. For example, whilst some argue that the classification of gaming disorder within the ICD-11 will help combat over-pathologisation by increasing research on clinical cases, such official recognition could also be used to legitimise the pathologisation of gaming as a socially undesirable behaviour. So, clinicians who may use ICD-11's gaming disorder criteria in the future should be mindful of motivations, by individuals, families and society, to pathologise what is nearly always going to be a benign or even protective behaviour. Further research is needed into how structural elements within games interact with a person's social environment and psychological well-being to cause disordered gaming. Loot boxes and other chance items may eventually be removed from some games via legislation or through public pressure on the industry, but some of the big players in the industry appear resistant to change. Perhaps some sensible and ethical practice from all those involved could eliminate the need for further pathologisation of players and games.

Authored by Stephen Kaar

References

  1. Eitan, S., Michael, EA., Bates, S., Horrax, C. (2017). Opioid addiction: Who are your real friends? Neuroscience & Biobehavioral Reviews. 83: 697-712,  https://doi.org/10.1016/j.neubiorev.2017.05.017
  2. Eurogamer, 2019. https://www.eurogamer.net/articles/2019-06-18-fifa-19-doesnt-use-eas-dynamic-difficulty-adjustment-patents-dev-insists
  3. King, D., Delfabbro, P., & Griffiths, M. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction. 8(1), 90-106. http://dx.doi.org/10.1007/s11469-009-9206-4
  4. Müller, KW., and Wölfling, K. (2017). Both sides of the story: Addiction is not a pastime activity. Journal of Behavioral Addictions. 6:2, 118-120. https://doi.org/10.1556/2006.6.2017.038
  5. Weinstein, N., Przybylski, AK., Murayama, KA. (2017). A prospective study of the motivational and health dynamics of Internet Gaming disorder. PeerJ. 5:e3838.  https://doi.org/10.7717/peerj.3838
  6. Pontes, HM., Király, O., Demetrovics, Z., Griffiths, MD. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming disorder: the development of the IGD-20 Test. PLoS One. 9(10):e110137.  https://doi.org/10.1371/journal.pone.0110137
  7. van Rooij, AJ., Ferguson, CJ., Colder Carras, M., Kardefelt-Winther, D., Shi, J., Aarseth, E., et al. (2018). A weak scientific basis for Gaming disorder: Let us err on the side of caution. Journal of Behavioral Addictions. 7(1), 1–9.  http://doi.org/10.1556/2006.7.2018.19
  8. Venniro, M., et al. (2018). Volitional social interaction prevents drug addiction in rat models. Nat Neurosci 21(11): 1520-1529.  https://doi.org/10.1038/s41593-018-0246-6
  9. Strickgold, R., Malia, A., Maguire, D., Roddenberry D., O'Connor, M. (2000). Replaying the Game: Hypnagogic Images in Normals and Amnesics. Science. 13 Oct: 350-353.  http://doi.org/10.1126/science.290.5490.350
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