Next week I have the pleasure of presenting two of our studies on Game Transfer Phenomena at the Royal Australian & New Zealand College of Psychiatrists (RANZCP 2023) congress in Perth, Australia.

The first paper focuses on a clinical case of GTP and Psychosis from the Fiona Stanley Hospital.

The second paper is a study examining the role of ADHD and dissociation symptoms in Gaming Disorder and GTP.

Game Transfer Phenomenon (GTP), Gaming Disorder and Psychosis

K H Le1, A Callan1, D Poynton1, A Ortiz de Gortari2, W Chen1
1Fiona Stanley Hospital, Murdoch, Perth, Australia
2Faculty of psychology, University of Bergen, Bergen, Norway
3University of Western Australia, Perth, Australia
4Curtin Medical School, Curtin University, Perth, Australia
5Curtin enAble Institute, Curtin University, Perth, Australia

Background: Game Transfer Phenomena (GTP) refers to involuntary transfer of in-game experiences to off-game real life in non-psychotic people after prolonged gaming. GTP often involves hearing or seeing video game contents after stopping playing; and can include perceiving unusually detailed features of the visual graphics or audial themes of a game, associated with tactile and kinaesthetic sensory misperceptions. There are two broad types of GTP perceptions: (i) endogenous (seeing images with closed eyes, hearing music inside one’s head) and (ii) exogenous phenomena (seeing objects and hearing sounds outside one’s body). GTP can be confused with psychotic hallucinations; and misclassified as psychotic experiences. In this presentation we describe a case of GTP and Gaming Disorder (GD) over-lapping with an episode of paranoid schizophrenia relapse.

Objectives: This presentation aims to (i) describe GTP in GD and (ii) demarcate GTP from psychotic features, thereby informing effective multimodal management.

Methods: We conducted a literature review on GTP, which informed this case report of a 24-year-old male who was referred to the Gaming Disorder Clinic at Fiona Stanley Hospital.

Findings: This patient’s GTP occurred in the context of an episode of paranoid schizophrenia relapse, associated with recent cannabis use, social withdrawal, and excessive video gaming. As an inpatient, his psychotic symptoms and GTP improved with a combination of medication therapy and GD intervention. Accurate differential diagnosis enabled him to access the state-of-art multimodal treatment.

Conclusions: Our case report highlights the importance of recognising GTP for early intervention and preventing misclassification or mischaracterisation as treatment-resistant psychosis.

The Role of ADHD and Dissociation Symptoms in Gaming Disorder and Game Transfer Phenomena

Angelica B. Ortiz de Gortari1,2 Maria Panagiotidi3
1 The Centre for the Science of Learning & Technology; University of Bergen, Norway.
2 University of Liège, Belgium. 
3 Department of Psychology, University of Sheffield. 

Background: The effects of gaming have been investigated from two perspectives: (i) excessive/uncontrollable playing (gaming disorder, GD), and (ii) Game Transfer Phenomena, (GTP), which includes multifarious changes in perceptions (distortions or misinterpretations of physical objects, hallucinations with game images/sounds), intrusive thoughts, and automatic behaviours. Dissociation and failures in attention and impulse control are potential underlying factors in GD and GTP.

Objectives: To evaluate the role of inattention, impulsivity, and dissociations in GD and GTP.

Methods: Gamers recruited online via an on-demand data collection platform (Sample1=247; Sample2=207; 18‒50 years old) completed self-report measures on GD, GTP, symptoms of ADHD and dissociation, and cognitive failures.

Findings: The prevalence of GD was 2.4% in Sample1 and 3.9% in Sample2. ‘Moderate/ severe GTP’ occurred in 19% in Sample1 and 23.2% in Sample2; in contrast, mild GTP were common (Sample1=77%; Sample2=72.9%). GD and GTP were strongly correlated. In the linear regression models for GD, the scores of ADHD, dissociation, and lapses in attention emerged as predictors. In the logistic regression models for GTP severity, ADHD, dissociation, and cognitive failure scores increased the likelihood of ‘moderate/severe GTP’. 

Conclusions: Considering ADHD and dissociation susceptibility appear important when evaluating GD and GTP because: (i) poor impulse control can lead to excessive playing and impulsive responses toward game-related cues, (ii) failures in sustained attention can facilitate intrusions with game content, and (iii) tendency to dissociate can increase both (a) the sense of embodiment of game controllers/characters, and (b) the absorption in the game leading to prolonged gaming sessions.