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uncertainty among the boundaries that differentiate very committed players from
those for whom it poses a problem (Aarseth etal., 2017; Ferguson and Colwell, 2020).
Galanis etal. (2021) warn about the possible misclassication of regular, but
non-problematic, players with a pathological label that could generate stigma.
However, it is also argued that the advantages of these labels outweigh the disadvan-
tages, as they favor the development of better treatment protocols and facilitate
prevention campaigns (Pontes etal., 2022). In this respect, Galanis etal. (2023)
pointed out that it is unlikely that the concept of “game addiction” is a determining
factor in public stigma.
The behavior of problematic video game use is perceived as controllable, gener-
ating anger and guilt in observers (Casale etal., 2023). Although less stigmatizing
than problematic gambling (Peter etal., 2018), video games often include micro-
transactions, such as loot boxes, power-ups, and coins, which can disrupt the play-
er’s spending. This suggests a growing convergence between video games and
gambling, which could increase the stigma toward video game addiction. Thus,
more research is needed to understand possible stigmatization processes similar to
those observed in problematic gambling.
6.4 Vulnerability toStigma inBehavioral Addictions
Stigma in problematic gambling particularly affects vulnerable groups, with women
being one of the most affected. Women players tend to choose games in discreet
places to avoid being seen and judged and avoid betting houses due to derogatory
comments they receive, even from other players (Estévez etal., 2023). This stigma
implies a double penalty: being a woman and a player (Estévez etal., 2023). This
occurs because they do not conform to traditional gender roles (Martínez-Redondo
and Arostegui-Santamaría, 2021), facing prejudices that label them as bad mothers
or workers, negligent, irresponsible, incompetent, and selsh, generating rejection
in their environment (Estévez etal., 2023; Casey, 2006; Holdsworth etal., 2012).
This transgression of gender expectations leads to feelings of guilt and shame,
making it difcult to seek support (Hing etal., 2016) and increasing self-stigma in
women to a greater extent than in men (Hing and Russell, 2017). This represents a
signicant barrier to access to treatment, especially considering the frequent comor-
bidity with disorders such as depression, anxiety, and substance use (Desai and
Potenza, 2008). In fact, suicide is the main cause of death in women players (Althaus
etal., 2021).
Family support for women is limited and often comes from other women (Rius-
Buitrago etal., 2021), while partners may despise or mistreat them (Lamas etal.,
2018). In contrast, men receive more family support and social justication
(Martínez-Redondo and Luján-Acevedo, 2020). Although women are more likely to
contact help centers, men are more likely to attend the appointment for an evalua-
tion (Weinstock etal., 2011).
V. J. Villanueva-Blasco et al.
75
Other vulnerable groups include people with low incomes and minorities, who
face greater stigmatization compared to individuals with higher incomes, who usu-
ally have more access to treatment, possibly due to higher education and less stig-
matizing attitudes (Holdsworth etal., 2015; Horch and Hodgins, 2015).
6.5 Addressing Stigma inBehavioral Addictions
6.5.1 Interventions toReduce Stigma
Strategies to reduce stigma in behavioral addictions are limited, but some from
other areas could be adapted. Brown and Russell (2019) describe interventions for
stigma in problem gambling, previously used in stigmatized conditions such as
mental illness (Corrigan etal., 2012). Riordan etal. (2021), based on guidelines for
alcohol treatment, recommend person-centered practices, non-stigmatizing lan-
guage, and training for professionals to reduce stigma. These strategies could be
applied to both problem gambling addiction and video game addiction.
6.5.2 Contact
Contact interventions aim to reduce stereotypes through interactions between indi-
viduals unfamiliar with a condition and affected individuals, who share their experi-
ences and recovery processes (Arboleda-Flórez and Stuart, 2012). These
interventions increase the empathy of outsiders and decrease the anxiety of affected
individuals when addressing the condition (Thornicroft etal., 2016), facilitating
identication and reducing the perception of loneliness (Corrigan et al., 2012).
However, these interventions can foster compassion and affect the feeling of auton-
omy (Corrigan and Fong, 2014). Their effectiveness depends on awareness of the
gambling disorder (Corrigan etal., 2012; Hing etal., 2016; Holmes etal., 1999).
6.5.3 Education
Educational interventions aim to counteract stereotypes and negative attitudes
through truthful information about the gambling disorder (Arboleda-Flórez and
Stuart, 2012), addressing how it develops and questioning erroneous beliefs
(Eldredge etal., 2016). However, the presentation of data can increase social dis-
tancing if it highlights differences between the public and the stigmatized group
(Palmer etal., 2018). The effectiveness of these interventions depends on the level
of awareness of the problem (Holmes etal., 1999).
6 Stigma andBehavioral Addictions: Problematic Gambling andVideo Game Addiction
76
6.5.4 Use ofLanguage
The use of language in public campaigns is crucial, as emphasizing personal respon-
sibility can generate negative attitudes toward those suffering from gambling prob-
lems (Miller & Thomas, 2017). Inclusive and person-centered language is
recommended, avoiding pejorative terms, labels, and expressions that attribute
blame (Healy etal., 2022).
6.5.5 Advocacy
Advocacy interventions focus on the gambling disorder as a social justice issue,
rejecting the associated negative stereotypes (Arboleda-Flórez and Stuart 2012),
pointing out the interests of the gaming industry and the responsibility of the gov-
ernment, reducing the player’s responsibility (Hancock and Smith, 2017; Miller and
Thomas, 2017; Thomas etal., 2016). Increasing community awareness and reduc-
ing stigma facilitates family and friends’ support, essential for help-seeking behav-
ior in reducing barriers to treatment (Itäpuisto 2019; Wieczorek and
Dąbrowska, 2018).
6.5.6 Person-Centered Practice
Person-centered practice, which fosters compassion, respect, and patient participa-
tion, is key in the treatment of mental disorders (Sharma etal., 2015). In behavioral
addictions, it is necessary to involve the family, as parental behavior inuences the
evolution of the disorder (Bonnaire etal., 2019; Li etal., 2019).
Brown and Russell (2019) suggest that it is necessary to employ all intervention
modalities to address stigma comprehensively. Depending on a single style of inter-
vention may not address all aspects of stigma, which could be counterproductive. In
addition to the proposed interventions, according to Brown and Russell (2019),
“advocacy actions” are crucial. These are interventions aimed at reframing the prob-
lem, shifting the focus of attention from the individual to the collective. Such actions
will necessarily involve multiple recipients, including not only players and their
families but also communities, services, stakeholders, and policymakers.
V. J. Villanueva-Blasco et al.
77
6.6 Prevention ofStructural andProvider Stigma
The place where treatment is offered can inuence stigmatization (Rolando etal.,
2023). Satel (2007) warned that sometimes medical and mental health professionals
endorse stigmatizing attitudes toward mental illness, which could also apply to
these behaviors. There are also studies that point to a lack of willingness to provide
treatment by health professionals, considering that, for example, video game disor-
der should not be considered a mental health problem (Dullur and Hay, 2017). This
fact not only interferes with access to treatment but could also interfere with future
searches for it and the development of self-stigma.
Therefore, explicitly addressing stigma from the beginning of treatment can
improve adherence to it and recovery (Hing and Russell, 2017). In addition, includ-
ing outreach services or online counseling would help attract people who, for many
reasons, do not want to access face-to-face services (Rodda etal., 2013).
6.7 Promoting Coping withSelf-Stigma
Self-stigma in behavioral addictions occurs when a person internalizes negative ste-
reotypes associated with their disorder and applies them to their identity (Corrigan
etal., 2009). A common coping mechanism is to hide the problematic behavior
(Hing and Russell, 2017), which, although it reduces shame, prevents the recogni-
tion of the problem and the search for help, hindering recovery (Nuske and Hing,
2013). Shame, fear of rejection, and social judgment about treatment discourage
help-seeking (Hing etal., 2014), while the effort to hide the problem generates anxi-
ety and stress (Corrigan etal., 2013).
Revealing the problematic behavior can result in social disapproval, but it also
reduces stress and facilitates family support, reducing self-stigma and improving
quality of life (Corrigan etal., 2010). Admitting the problem is effective in combat-
ing self-stigma and reducing isolation. Moreover, when a person agrees with stereo-
typed beliefs, they are less likely to seek help, as they try to distance themselves
from the stigmatized group. On the other hand, people who attend treatment per-
ceive fewer stereotypes, although it is not clear whether this is a result of the treat-
ment or facilitated the search for help (Hing and Russell, 2017).
6.8 Stigma Associated withClinical Diagnosis
Corrigan (2000) has pointed out that diagnostic labels and other indicators of men-
tal illnesses can act as foundations for the creation of stereotypes and prejudices.
This type of prejudice tends to manifest in negative behaviors, including hostility,
discrimination in areas such as housing, employment, or access to treatments, and,
6 Stigma andBehavioral Addictions: Problematic Gambling andVideo Game Addiction
78
especially, in avoidance behaviors toward the affected people (Corrigan, 2000).
Thus, diagnostic labels can be particularly prone to generating stigmatizing percep-
tions in relation to people with behavioral addictions, providing a basis for the
emergence of stereotypes (Corrigan, Markowitz etal., 2003). In line with this, Peter
etal. (2018) observe that the diagnostic label of gaming or video game disorder
increases stigma compared to control conditions without diagnosis. However, other
studies (Palmer etal., 2018; Quigley etal., 2019) support the conclusion that the
label used to describe the gaming disorder does not affect attitudes and stigma
toward the disease. These results suggest that the more recent term “gaming disor-
der,” introduced in the DSM-5 (APA, 2013), does not provoke more stigma than its
predecessor “pathological gambling” in the DSM-IV (APA, 1994). Similarly, the
terminology used to describe video game addiction seems to have little impact on
the stigma toward gamers (Galanis etal., 2023). In short, further research is needed
to clarify this key issue in relation to stigma in people with behavioral addictions.
The stigmatization of gaming disorder cannot be reduced with a simple change
of terminology (Quigley etal., 2019). In the case of substance addictions, it has
been proposed to reconceptualize substance use disorders as prolonged excessive
use (Rehm etal., 2013; Rehm etal., 2014). This way of considering them is less
stigmatizing than the label of “addiction,” as it presents the consumption behavior
as a continuum in which problematic consumptions are at one end (Rehm etal.,
2013). In non-substance addictions, since most people perform some of these
behaviors regularly, they could be located at different points on the continuum. This
perspective would help to reduce stigma, focusing efforts on reducing it and thus
freeing the behavior from the moral and disease connotations associated with the
label of “addiction” (Hing etal., 2016).
6.9 Stigma andOverpathologization
In the last decade, a worrying trend has emerged in the eld of mental health and
addictions, which consists of overpathologizing certain disruptive behaviors, usu-
ally derived from frequent and intensive use of digital devices, video games, the
Internet, or social networks, from the moment it generates some type of interference
in daily life. According to experts, it is possible that, in an attempt to categorize and
better understand human behavior, we have fallen into the temptation to pathologize
the everyday, simply because at some point it may become problematic, dysfunc-
tional, or maladaptive (Kardefelt-Winther etal., 2017). Using criteria typical of
substance addictions, such as tolerance or withdrawal syndrome, health profession-
als have begun to label daily activities, ranging from video game use to physical
exercise, also as “addictions.” But what part of the epidemiology that we are build-
ing today is really a true addiction in clinical terms? What could simply be an exces-
sive passion or enthusiasm can become a cause for concern and clumsily labeled as
a pathology (Billieux etal., 2019). This could trigger an alarm cycle leading to
unnecessary therapeutic interventions, a saturation of health devices, and a loss of
V. J. Villanueva-Blasco et al.
79
condence in the behavioral sciences themselves. We are at risk of treating as sick
people who are not, thus weakening the credibility of our discipline and causing the
stigmatization of those we are supposed to be helping.
Recognizing the problem and avoiding its trivialization does not mean overdi-
mensioning it, a risk that could lead us to overpathologize it and confer a clinical
character when it may not have it (Nogueira-López etal., 2023). In this sense, an
analysis and reection must be carried out to adequately dene and quantify the
problem. It is necessary for the eld of mental health to be able to timely redene
addictive behaviors, focusing on symptoms that truly reect a signicant and persis-
tent clinical dysfunction. Faced with the initial risk of trivializing the problem that
the emergence of new addictions (especially in adolescence) can pose, the risk also
grows of positioning ourselves on the opposite side, which reinforces the need to be
especially rigorous in this eld, using good diagnostic criteria and appropriate
instruments. In short, an accurate diagnosis enables both professionals and affected
individuals to better understand and contextualize the issue, facilitating more effec-
tive intervention and reducing the stereotypes and beliefs that fuel stigma, often
stemming from the inappropriate use of diagnostic terms.
6.10 Final Considerations: Proposals fortheDesign
ofPublic Policies Aimed at Reducing theStigma
Associated withProblem Gambling andVideo
Game Addiction
When addressing the stigma associated with problem gambling and the addiction to
video games, public policies should consider several key implications:
(a) Integration of mental health: Public policies should recognize these behaviors
as mental health problems and integrate treatment for them within broader men-
tal health services. This approach can destigmatize these conditions and encour-
age people to seek help without fear of being judged (Gainsbury etal., 2014).
(b) Awareness and education campaigns: It is essential to raise awareness about
the nature of addiction to gambling and video games. Educational programs
aimed at the public and health professionals should highlight the behavioral and
psychological foundations of these addictions to reduce public stigma.
(c) Policy reforms: Policies should reect the most recent scientic understanding
of these issues. For example, their diagnostic classication in the DSM and ICD
recognizes their legitimacy as a mental health condition, which potentially
reduces stigma. Public policies that align with such classications are essential
to promote non-discriminatory treatment frameworks.
(d) Support and access to treatment: Stigma often prevents people from seeking
help. It is essential to ensure accessible and unbiased treatment options. Policies
that expand access to support systems, such as anonymous telephone lines,
6 Stigma andBehavioral Addictions: Problematic Gambling andVideo Game Addiction
80
online counseling, and peer support groups, can mitigate the fear of stigmatiza-
tion (Kuss and Grifths, 2017).
(e) Regulation and advertising: It is necessary to tighten advertising regulations for
gambling and online games, especially with regard to their exposure to minors.
Similarly, it is necessary to regulate the incorporation of elements of gambling
and betting into video games, such as loot boxes. Policies that regulate how
these activities are promoted can reduce normalization and help manage public
perceptions, which otherwise could contribute to stigma.
The incorporation of these considerations into public policies will help reduce
stigma and create a more favorable environment for people affected by problem
gambling and video game addiction.
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6 Stigma andBehavioral Addictions: Problematic Gambling andVideo Game Addiction