Social Workers’ Perceptions of the Association Between Role Playing Games and Psychopathology

  • Menachem Ben-Ezra
  • Eric Lis
  • Agata Błachnio
  • Lia Ring
  • Osnat Lavenda
  • Michal Mahat-Shamir
Original Paper


Whereas role-playing and table-top role-play games (RPGs) have been proven to have potential as therapeutic tools, playing RPGs is often stereotypically associated with social incompetence and psychiatric disorders. Knowledge regarding the stereotype and its implications is very scarce specifically among mental health practitioners. Therefore the present study aimed to narrow this gap in knowledge by examining the perception of Social Workers that are considered to be the forefront of mental health-care, in regard to the association between playing RPGs and mental health. A convenience sample of 130 Social Workers, recruited through social networks (e.g. Facebook, WhatsApp etc.), responded to an on-line survey dealing with their perception of their own knowledge on RPGs, the importance of such knowledge and the association between playing RPGs and mental illness. Results indicated an association between having higher knowledge of RPGs and lower perception of a link between playing RPGs and psychopathology. The study’s findings emphasize the false stigma and its potential harmful implication on professionals’ practice, especially in the context of intake process and primary diagnostic. The effect of familiarity is also discussed in light of the study’s findings.


• The perception of mental health professionals toward role playing games such as Dungeons and Dragons is understudied.

• Social Workers' perception was measured in regard to the connection between use of RPGs and DSM-IV-TR psychopathology.

• Greater knowledge of RPGs was found to be associated with lower perception of the connection between use of RPGs and DSM-IV-TR psychopathology.


Social workers Role playing games Dungeons & Dragons 


Since its release in 1974, the pioneering game Dungeons and Dragons (D&D) opened the era of table-top role-playing games (RPGs) [1]. Initially, the game appealed only to a minor literati. However, with the passage of time, D&D has become a renowned phenomenon as part of mainstream gaming. D&D helped to inspire a plethora of other gaming systems, such as Ars Magica, GURPS, and many others. These games have impacted youth, adolescents and adults, especially in the Western World. In spite of its impact on culture and society, only a few studies have looked at D&D within the mental health context and mental health professionals’ attitudes toward the game by are still shrouded. One study has examined the implications of D&D on therapy [2]. One recent study has addressed the usefulness of RPGs and massively-multiplayer online role-playing games (MMORPGs) as therapeutic tool in narrative therapy [3]. A preliminary work by Lis et al. [4] showed that among psychiatrists, only 22% believe that there is an association between playing RPGs and psychopathology, which is significant given that movies and television series often depict RPG-players stereotypically as socially inept and often suffering from psychiatric disorders [4]. However, other mental health professionals, notably the social workers who are often on the front-lines of community mental health care, were not studied, and no data exists on whether they endorse such stereotypes. Although social workers are trained in cultural sensitivity as a part of their training, socio-cultural sensitivity doesn’t include RPGs, and therefore it would seem important to learn about their perception of D&D and other such games. It is important to know if social workers hold stigma towards the millions of people who play such games, as such beliefs may impede treatment and even create hostility towards the mental health professional. Based on the above, we have formulated the following hypotheses: 1) RPGs will be perceived by a majority of social workers as being associated with at least one DSM–IV-TR diagnosis; 2) Greater knowledge regarding RPGs will be associated with less perception of the association of playing RPGs with at least one DSM–IV-TR diagnosis.



Social Workers were recruited by sending out invitations to M.S.W students (all licensed social workers) for participation. A recruitment letter was distributed via email/Facebook/Whatsapp which linked to an electronic questionnaire hosted on the survey site ( Data collection was conducted in a period of less than two months (24.12.16–07.2.17). The participants were licensed social workers who were currently being employed. We used the Hebrew version of a questionnaire that was used before [4, 5]. Ethics approval was obtained from the Ariel University ethics committee at the faculty of social sciences and Humanities. Each participant electronically signed a consent form prior to completing the questionnaire.


The sample consisted of 130 social workers with mean age of 38.98 (SD = 9.26; ranging from 24 to 64), of whom 109 (83.8%) were women. The mean years of experience was 11.95 (SD = 9.58; ranging from 1 to 40 years). Due to the high correlation between age and years of experience (r = 0.874; p < 0.001), we have omitted the variable years of experience in order to prevent multi-collinearity problems.


Beyond demographics, each social worker answered the following questions:

Knowledge regarding RPGs was measured by the question: “How knowledgeable do you feel about RPGs such as Dungeons and Dragons and/or other similar games” ranging from ‘1’ (no knowledge at all) to ‘5’ (highly knowledgeable). The mean score was 1.66 (S.D = 1.00). Only 19.2% of the social workers scored 3 or above to indicate having knowledge of RPGs.

Social Workers’ perceptions of the importance of having knowledge about RPGs was measured by the question, “How much it is important for social workers to learn more about RPGs,” ranging from ‘1′ (not important at all) to ‘5′ (very important). The mean score was 3.04 (S.D = .98). 76.2% scored 3 or above indicating that they think it is important to learn more about RPGs.

The final set of questions asked participants to report whether they believed that there is an association between playing RPGs and having mental health problems, based on the DSM-IV Categories.

The first questions was a general one: “Do you feel that there is a link or association (causative or not) between use of table-top RPGs and mental disorders?’ with two possible answers: ‘1′ (no) and ‘2′ (yes).

Beyond the general question, we asked the participants, “what is the magnitude of the association between the following categories of the DSM-IV with the use of RPGs?” each rated on a five point Likert scale ranging from ‘1’ (not correlated at all) to ‘5’ (perfectly correlated). This question was asked for the following seven categories: 1. Major depression. 2. Social anxiety. 3. Other anxiety disorders. 4. Psychosis. 5. Substance abuse. 6. Personality disorders. 7. Attention Deficiency Hyperactive disorder (ADHD).

Statistical Analysis

We conducted descriptive statistics of the study variables. Following that, we conducted a logistic regression with age, gender, knowledge about RPGs, and the importance of knowledge about RPGs for Social Workers as independent factors, while the association between using RPGs and mental disorders was the dependent variable. For each factor, we obtained an odds ratio and 95% confidence interval. In addition, we conducted a set of regressions with each of the aforementioned DSM-IV categories as the dependent variable and the same independent factors as in the logistic regression. We conducted a multicollinearity test that revealed a tolerance ranging from 0.856–0.956 and Variation Inflation Factor (VIF) ranging from 1.043–1.169 showing no indication of multicollinearity [6]. Statistical analyses were conducted with SPSS version 23 (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.).


More than one third of the social workers (34.6%; n = 45) stated that they believe there is a connection between playing RPGs and DSM-IV-TR psychopathology. However, only 19.2% (n = 25) of the social workers indicating having knowledge of RPGs while 76.2% (n = 99) stated that it’s important to learn more about RPGs.

The logistic regression revealed that being older (OR = 0.947; 95% C.I. [0.904–0.991]; p < 0.05) and having higher knowledge of RPGs (OR = 0.595; 95% C.I. [0.365–0.969]; p < 0.05) were associated with the perception of a lower connection between the use of RPGs and mental disorders. However, social workers who thinks that it is important to learn more about RPGs tend to associate the higher connection between the use of RPGs and mental disorders (OR = 1.753; 95% C.I. [1.129–2.722]; p < 0.05) (Table 1).

The subsequent set of regressions revealed two important patterns. Having higher knowledge of RPGs was significantly associated with the lower ranking of correlation between use of RPGs and social anxiety (β = −.271; t = −3.002; p = .003), anxiety (β = −.211; t = −2.280; p = .024), substance abuse (β = −.234; t = −2.572; p = .011), and ADHD (β = −.217; t = −2.2354; p = .020).

On the other hand, higher importance for social workers to learn more about RPGs was significantly associated with higher ranking of correlation between use of RPGs and major depression (β = .206; t = 2.298; p = .023), social anxiety (β = .259; t = 3.003; p = .003), anxiety (β = .222; t = 2.515; p = .013), and ADHD (β = .227; t = 2.578; p = .011).
Table 1

Logistic regression between the study variables and the association between using RPGs and mental disorders among social workers (n = 130)




Association between using RPGs and mental disorders




Odds ratio

95% C.I

Age (years)












Knowledge of RPGs






Importance of RPGs knowledge for Social Workers






*p < 0.05. **p < 0.01. ***p < 0.001


One third of the social workers who completed this questionnaire stated that there is a connection between playing RPGs and DSM-IV-TR psychopathology. This result is contradictory to our hypothesis, as we expected that a majority of social workers would perceive playing RPGs as associated with psychopathology. However, with regard to the second hypothesis, we found that having higher knowledge of RPGs was associated with lower perception of a link between playing RPGs and psychopathology. Those who claimed that it is important for social workers to learn more about RPGs had higher perception of the connection between playing RPGs and psychopathology.

This intertying pattern, where less than 20% of the social workers report having knowledge about RPGs while a little more than 75% of the social workers agree that social workers should learn more about RPGs, was not only related to the general association between playing RPGs and psychopathology, but also to specific disorders such as social anxiety, other anxiety disorders and substance abuse.

One possible explanation may be the familiarity effect, i.e. familiarity induced by prior exposure may lead to more positive judgments [7, 8]. Thus, when a social worker is versed in RPGs such as D&D, the likelihood that he/she will perceive playing RPGs as associated with psychopathology is lower in comparison to a social worker who is not knowledgeable about RPGs. Social workers who associate playing RPGs with psychopathology are more likely to think it is important to learn about RPGs. This may be due to their training emphasizing that professionals can handle culturally-sensitive therapy by becoming more acquainted with the clients’ culture, viewpoints, and explanatory model in order to successfully connect with them [9].

Contrary to the previous study [4], it seems that social workers may be less likely to have played RPGs than members of the general public. An explanation for this may be that, consistent with previous research showing that social workers are more conservative in comparison to the general population [10], they may also tend to seek out less exposure to fantasy and science fiction.

Finally, we should take into account socio-cultural issues. D&D is less popular in Israel than in North America and was regarded with suspicion in the general public except of few enthusiastic players. However, this has changed dramatically over the course of time as D&D became a part of mainstream gaming. Still, there is a cultural gap that may prevent D&D from becoming as popular as it is in North America. To date, it is estimated that there are more than 20 million people played D&D since its creation [11]. In Israel, the number of D&D estimation is about tens of thousands players as of 2007 [12].

Our study has a number of important limitations. The study’s sample is a convenience sample of social workers. Our results may not be generalizable to social workers in other countries until a cross-cultural study is conducted. There is always the possibility of response bias. Our online questionnaire was distributed by email, forums, Facebook, and WhatsApp applications so more computer-literate social workers were sampled.

Nevertheless, the present study is one of the few to recognize the potential impact of RPG playing stigma on mental health professionals. It emphasizes the need to conduct more studies to investigate the scope of RPG playing stigma and the extent of its implication on professionals’ practice. It is important to replicate the present study’s findings and to examine the phenomena with other samples of social workers as well as with a variety of mental health practitioners.


This study represents the first data collected on social workers’ perceptions of RPGs, a significant cultural phenomenon associated with stereotypes related to mental health. It seems that having knowledge of RPGs reduces a social worker’s perception of RPGs being associated with psychopathology while the belief that social workers should learn more about RPGs increases this perception.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Menachem Ben-Ezra
    • 1
  • Eric Lis
    • 2
  • Agata Błachnio
    • 3
  • Lia Ring
    • 1
  • Osnat Lavenda
    • 1
  • Michal Mahat-Shamir
    • 1
  1. 1.School of Social WorkAriel UniversityArielIsrael
  2. 2.McGill University Psychiatry Perceptions of Emerging Technologies LabsMontrealCanada
  3. 3.Institute of PsychologyThe John Paul II Catholic University of LublinLublinPoland

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