Internet Gaming Disorder (Gaming Disorder)

Overview

Internet Gaming Disorder (IGD), also known as Gaming Disorder, is a behavioural addiction characterised by persistent and recurrent gaming behaviour that leads to clinically significant distress or impairment in personal, social, educational, or occupational functioning. It involves impaired control over gaming, increasing priority given to gaming over other activities, and continuation or escalation of gaming despite negative consequences.

While gaming can be a healthy form of entertainment, relaxation, and social connection, excessive or uncontrolled gaming can negatively affect daily life and relationships for a small proportion of individuals.

Gaming Disorder is recognised in the ICD-11, while Internet Gaming Disorder is included in the DSM-5 as a condition requiring further study, reflecting growing recognition of problematic gaming behaviours alongside the need for continued research.

What Does It Feel Like?

For the Individual

Living with Internet Gaming Disorder involves experiencing a complex pattern of behaviours and consequences that can feel overwhelming and difficult to control:

Loss of Control: A defining feature of gaming disorder is impaired control over gaming habits. Individuals often find it difficult to limit how long or how often they play, even when they intend to stop.

Preoccupation and Priority: Gaming may gradually become the central focus of daily life, taking precedence over school, work, relationships, and other interests. Some individuals also use gaming as a way to escape stress, emotional distress, or personal difficulties.

Tolerance and Escalation: Over time, individuals may feel the need to spend increasing amounts of time gaming to achieve the same level of enjoyment or satisfaction, continuing to play despite negative consequences.

Withdrawal Symptoms: When gaming is interrupted or unavailable, some people experience emotional discomfort such as irritability, sadness, anxiety, restlessness, or frustration.

Functional Impairment: Excessive gaming can interfere with responsibilities and self-care, contributing to declining academic or work performance, disrupted routines, and reduced attention to personal hygiene or daily tasks.

Deception and Secrecy: Some individuals may hide or minimise the amount of time spent gaming, particularly when they are aware of concerns expressed by family members or others.

Neurobiological Changes: Research suggests that gaming activates reward pathways in the brain involving dopamine, with some neurological findings showing similarities between problematic gaming and other addictive behaviours.

Real-World Consequences: In severe cases, excessive gaming may contribute to significant physical and psychological strain, including severe sleep deprivation, neglect of health needs, social withdrawal, and stress-related health complications.

For Family Members and Loved Ones

Family members and friends of individuals with Internet Gaming Disorder often experience:

Educational Concerns: Excessive gaming may contribute to declining academic performance, reduced school attendance, difficulty concentrating, and, in some cases, school refusal or disengagement from education.

Social Isolation: Loved ones may notice increasing withdrawal from family interactions, friendships, and social activities as gaming becomes the individual's primary focus.

Sleep Disruption: Gaming that extends late into the night can lead to disrupted sleep patterns, chronic fatigue, and difficulty waking for school, work, or daily responsibilities.

Family Relationship Strain: Excessive gaming can create tension within families, particularly when it interferes with responsibilities, shared time, social participation, or other important activities.

Worry and Helplessness: Family members often feel distressed, frustrated, or powerless as they watch their loved one's life become increasingly dominated by gaming.

Financial Concerns: In some cases, excessive spending on games, in-game purchases, subscriptions, or gaming equipment may create financial strain and conflict within the household.

Symptoms and Diagnostic Criteria

WHO ICD-11 Diagnostic Criteria

The World Health Organisation defines gaming disorder with the following criteria:

1. Impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context)
2. Increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities
3. Continuation or escalation of gaming despite the occurrence of negative consequences
4. Significant impairment in personal, family, social, educational, occupational or other important areas of functioning
5. Duration: The behaviour pattern would normally have been evident for at least 12 months

DSM-5 Proposed Criteria

Internet Gaming Disorder in DSM-5 Section III as a condition for further study, with proposed criteria including:

1. Persistent and recurrent use of the internet to engage in games
2. Clinically significant impairment or distress as indicated by five or more of the following in a 12-month period:
   • Preoccupation with internet games
   • Withdrawal symptoms when internet gaming is taken away
   • Tolerance (need to spend increasing amounts of time engaged in internet games)
   • Unsuccessful attempts to control participation in internet games
   • Loss of interest in previous hobbies and entertainment
   • Continued excessive use despite knowledge of psychosocial problems
   • Deception regarding the amount of internet gaming
   • Use of internet games to escape or relieve negative moods
   • Jeopardising or losing significant relationships, jobs, or educational opportunities

Observable Signs and Symptoms

Behavioural Indicators:

• Poor performance at school, work, or household responsibilities
• Withdrawal symptoms when gaming is not possible
• Need for increasing gaming time for satisfaction
• Giving up other activities and social relationships
• Inability to reduce playing time despite negative consequences
• Lying about gaming time
• Decline in personal hygiene
• Using games to escape stress or negative emotions

Physical Health Signs:

• Physical collapse from gaming
• Medical episodes resembling mini-strokes
• Severe sleep deprivation
• Inability to wake up for school or work

Academic and Social Impact:

• School attendance dropping significantly (e.g., to 64%)
• Social isolation from friends and family
• Staying up until 2am gaming
• Gaming 8-10 hours per day

Assessment Considerations

Functional Impairment Focus: Assessment of Internet Gaming Disorder focuses not only on the amount of time spent gaming but, more importantly, on the individual's level of control and the extent to which gaming interferes with daily functioning. Clinicians evaluate how gaming affects sleep, eating habits, school or work performance, relationships, and overall wellbeing.

Duration Requirements: Symptoms are typically expected to be present for at least 12 months for a diagnosis of Gaming Disorder, although the duration may be shorter in cases where symptoms are severe and all diagnostic criteria are clearly met

Prevalence and Demographics

Global and Regional Prevalence

Global Statistics:

• Studies suggest that gaming disorder affects only a small proportion of people who engage in digital or video-gaming activities.
• Researchers estimate that video game addiction affects between 1.7% and 10% of the U.S. population.
• Almost 3.5 billion people around the world played video games in the previous year

United States:

• Prevalence estimates range from 1.7% to 10% of the U.S. population
• Early evidence suggests video games are among the most addictive technologies

Australia:

• Researchers estimate about 100,000 Australian teenagers are clinically addicted to gaming.
• Found 2.8% of teenagers surveyed met criteria for Internet Gaming Disorder
• 92% of Australians aged 5-24 play video games
• 65% of Australians regularly play, and 93% of households own at least one gaming device

United Kingdom:

• Hundreds of gamers, including children and their family members, have been treated by the NHS National Centre for Gaming Disorders.
• The NHS clinic saw its first patient in early 2020 and has been treating increasing numbers.

Demographic Characteristics

Age Distribution:

• Video game addiction can affect children, teens and adults, although adults are most likely to have this condition

• The NHS National Centre for Gaming Disorders treats individuals aged 13 years and over.

Gender Patterns:

• Research suggests higher prevalence in males, though gaming participation has become more gender-balanced
• The condition affects both male and female teenagers.

Risk Populations:

• Psychological risk factors may include impulsivity, low self-control, and anxiety.
• Psychological risk factors may include impulsivity, low self-control, and anxiety.

Treatment Seeking Behaviour

Low Treatment Rates: Similar to other behavioural addictions, many individuals with gaming disorder do not seek professional treatment.

Increasing Demand: Specialised clinics have reported growing numbers of gamers, including children and their family members, seeking support for problematic gaming behaviours.

Family Involvement: Treatment often involves family members, recognising the impact of gaming disorder on the broader family system.

Causes and Risk Factors

Neurobiological Factors

Dopamine and Reward Systems: Research suggests that playing and winning video games may trigger the release of dopamine, a neurotransmitter involved in reward, pleasure, and motivation. This process is similar to mechanisms seen in gambling and substance-related disorders.

Brain Similarities: Neurological research has identified similarities between the brains of individuals with gaming disorder and those with substance use disorders.

Tolerance Development: Over time, individuals may require increasing amounts of gaming to achieve the same level of satisfaction, reflecting patterns of tolerance similar to those seen in addictions.

Psychological Risk Factors

Mental Health Comorbidities: Psychological risk factors including:

• Impulsivity
• Low self-control
• Anxiety
• Depression (often co-occurring)
• ADHD (attention-deficit/hyperactivity disorder)

Coping Mechanisms: Individuals may use video games to relieve negative emotions, such as guilt or hopelessness, or as a way to escape stressful situations.

Game Design Factors

Addictive Design Elements: Modern video games are often highly sophisticated and intentionally designed to encourage frequent and prolonged engagement.

Variable-Ratio Rewards: Many games use unpredictable reward systems, where points, money, or new abilities are delivered randomly, similar to reinforcement patterns seen in gambling.

Loot Boxes: Features such as loot boxes can create cycles of anticipation and disappointment that reinforce continued play and emotional investment.

Social Features: Many modern games include social elements that can increase engagement and make it harder to stop playing.

Environmental and Social Factors

Social Isolation: Periods of social isolation, such as during the COVID-19 pandemic, have been associated with increased gaming problems, particularly among young people.

Accessibility: The widespread availability of gaming platforms and internet access contributes to risk.

Cultural Acceptance: The normalisation of extensive gaming in many cultures can make it difficult to recognise when gaming becomes problematic.

Behavioural Risk Factors

• Spending increasing amounts of money on gaming
• Increasing weekday gaming time
• Attending offline gaming community meetings
• Having gaming community membership

Differential Diagnosis and Assessment

Distinguishing Problematic from Normal Gaming

Control vs. Time: The level of control a person has over their gaming behaviour may be more important than the number of hours spent gaming alone.

Functional Impairment: Gaming becomes more concerning when it negatively affects sleep, eating habits, work, school, relationships, or other daily responsibilities.

WHO Perspective: Excessive gaming may be problematic when it begins to replace or interfere with other important daily activities and responsibilities.

Assessment Tools and Approaches

Comprehensive Evaluation:

• Gaming patterns and history
• Functional impairment across life domains
• Co-occurring mental health conditions
• Family and social impact
• Physical health consequences

Professional Assessment: Diagnosis typically involves assessment by a mental health professional, such as a psychologist or psychiatrist.

Comorbidity Considerations

Common Co-occurring Conditions:

• Depression and anxiety disorders
• ADHD
• Social anxiety
• Sleep disorders
• Academic or occupational problems

Differential Diagnosis: Important to distinguish gaming disorder from:

• Normal recreational gaming
• Gaming as a symptom of other mental health conditions
• Temporary increases in gaming during stressful periods

Treatment Approaches

Psychotherapy

Cognitive Behavioural Therapy (CBT): CBT is a primary treatment approach that helps individuals identify and change unhealthy thought patterns and behaviours related to gaming, while developing healthier coping strategies and habits.

Treatment Goals: CBT focuses on:

• Identifying and changing distorted thinking patterns about gaming
• Developing healthy coping strategies for urges and triggers
• Addressing underlying emotional issues
• Building relapse prevention skills
• Improving self-control and decision-making

Group Therapy: Group therapy can provide motivation, encouragement, and social support, particularly for individuals who have become isolated because of excessive gaming.

Family Therapy: Family or relationship counselling may help educate loved ones about the condition and support the development of a healthier and more stable home environment.

Specialised Gaming Disorder Services

NHS National Centre for Gaming Disorders: The NHS provides comprehensive specialised treatment including:

• Multi-disciplinary assessment and treatment
• Individual and group therapy
• Family support and education
• Collaboration with other mental health services
• Treatment for ages 13 and over across England and Wales

Treatment Approach: Treatment often involves collaboration with mental health teams and other professionals to provide comprehensive and coordinated care.

Behavioural Interventions

Gradual Reduction: Research suggests that taking short breaks from gaming, such as a weekend off, may help individuals reduce emotional dependence on gaming and view it as a less central part of daily life.

Structured Gaming: Rather than complete abstinence, some approaches focus on developing healthy gaming habits and time limits.

Alternative Activities: Developing engaging alternatives to gaming, including physical activities, social interactions, and other hobbies.

Medication Management

Limited Direct Pharmacological Options: No medications are specifically approved for gaming disorder, but treatment may include:

• Medications for co-occurring conditions (depression, anxiety, ADHD)
• Symptom management for withdrawal-like symptoms
• Treatment of sleep disorders or other physical health consequences

If you have another underlying mental health condition, such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD), your healthcare provider may recommend certain medications to treat the symptoms of the condition.

Prevention and Early Intervention

Primary Prevention

Awareness and Education: Individuals who engage in gaming are encouraged to monitor the amount of time spent gaming, especially when it begins to replace other important daily activities.

Healthy Gaming Habits: Moderated gaming and balanced screen use may help reduce the risk of problematic gaming behaviours.

Game Design Regulation: Concerns have been raised about gambling-like mechanics in games, leading to discussions about stricter regulation and safer game design practices.

Secondary Prevention

Early Recognition: Identifying early warning signs of problematic gaming patterns before they develop into full gaming disorder.

Brief Interventions: Short breaks from gaming may help individuals reduce emotional reliance on gaming and recognise that it is not an irreplaceable part of life.

Family Education: Helping families recognise warning signs and respond appropriately.

Risk Reduction Strategies

Balanced Lifestyle: Encouraging diverse activities and interests beyond gaming.

Social Connection: Maintaining real-world social relationships and activities.

Sleep Hygiene: Establishing healthy sleep patterns and avoiding late-night gaming.

Academic/Occupational Priorities: Maintaining focus on educational and career goals.

Complications and Consequences

Physical Health Consequences

Severe Physical Effects:

• Physical collapse from gaming
• Medical episodes resembling mini-strokes
• Severe sleep deprivation
• Inability to wake up for daily responsibilities

Mental Health Complications

Co-occurring Mental Health Issues: Gaming disorder often occurs alongside:

• Depression and anxiety
• Social anxiety and isolation
• Sleep disorders
• Attention and concentration problems

Emotional Regulation: Difficulty managing emotions without gaming as a coping mechanism.

Educational and Occupational Impact

Academic Consequences: Problematic gaming may contribute to declining school attendance, reduced academic performance, and increasing school refusal behaviours.

Occupational Impairment: Excessive gaming can negatively affect performance at school, work, or household responsibilities.

Long-term Career Impact: Prolonged gaming disorder can affect educational achievement and career development.

Social and Relationship Consequences

Social Isolation: Individuals with problematic gaming behaviours may withdraw from friends, family, and social activities, spending increasing amounts of time alone gaming.

Family Relationships: Excessive gaming can reduce family interaction and place strain on family relationships and communication.

Peer Relationships: Loss of real-world friendships and social connections.

Financial Consequences

Gaming-Related Expenses: Excessive spending on games, in-game purchases, and gaming equipment.

Opportunity Costs: Lost income or educational opportunities due to gaming-related impairment.

Living with Internet Gaming Disorder

Daily Management Strategies

Time Management: Setting structured and limited gaming periods may help individuals maintain a healthier balance and reduce excessive gaming behaviours.

Alternative Activities: Developing engaging alternatives to gaming, including physical activities, social interactions, and creative pursuits.

Sleep Hygiene: Establishing regular sleep schedules and avoiding late-night gaming.

Social Connection: Maintaining real-world relationships and social activities.

Recovery Considerations

Gradual Approach: Taking gradual breaks from gaming may help individuals reduce problematic behaviours while still maintaining gaming as a balanced hobby.

Value-Based Decision Making: Reflecting on personal values, priorities, and life goals can help individuals evaluate whether their gaming habits are supporting their overall well-being.

Achievement Focus: Reducing excessive gaming may allow individuals to focus more on personal growth, responsibilities, and meaningful achievements in other areas of life.

Family and Relationship Considerations

Family Education: Family understanding and involvement are important components of treatment and recovery for gaming disorder.

Communication: Developing open, honest communication about gaming and its impact.

Boundary Setting: Families learning to set appropriate boundaries while maintaining supportive relationships.

Professional Support: Engaging with mental health professionals who understand gaming disorder.

Crisis Management and Safety

Immediate Safety Concerns

Physical Health Emergencies: Severe cases of problematic gaming may lead to serious physical health complications requiring immediate medical attention.

Sleep Deprivation: Severe sleep disruption requiring immediate intervention.

Academic/Occupational Crisis: Significant impairment in school or work performance requiring immediate support.

Crisis Resources

United States:

• 988 Suicide & Crisis Lifeline: Call or text 988
• Crisis Text Line: Text HOME to 741741
• SAMHSA National Helpline: 1-800-662-4357
• Local mental health crisis services

United Kingdom:

• NHS National Centre for Gaming Disorders: cnwl.ncba.cnwl@nhs.net
• Samaritans: 116 123 (free, 24/7 emotional support)
• NHS 111: For urgent but non-emergency health concerns
• Local NHS crisis teams

Australia:

• Lifeline: 13 11 14 (24/7 crisis support)
• Beyond Blue: 1300 22 4636 (depression and anxiety support)
• Kids Helpline: 1800 55 1800 (for young people)
• Local mental health crisis services

Emergency Situations

Medical Emergency: Immediate contact with emergency services if individual experiences physical collapse or medical episodes.

Severe Sleep Deprivation: Professional intervention when sleep disruption becomes dangerous.

Suicidal Thoughts: Immediate crisis intervention if gaming-related problems lead to suicidal ideation.

Family Crisis: Crisis support for families dealing with severe gaming-related problems.

Research and Future Directions

Current Research Areas

Neurobiological Studies: Ongoing research into brain changes associated with gaming disorder and similarities to substance use disorders.

Treatment Development: Research into effective therapeutic approaches and treatment protocols.

Prevention Research: Studies on effective prevention strategies and early intervention approaches.

Game Design Impact: Research on how specific game design elements contribute to addictive gaming patterns.

Emerging Trends and Concerns

Increasing Prevalence: Growing concern has emerged regarding problematic gaming behaviours, particularly among teenagers and young people.

Game Design Evolution: Modern video games are increasingly sophisticated and designed to encourage frequent and prolonged engagement.

Loot Box Concerns: Features such as loot boxes have raised concerns among researchers and advocates because of their similarities to gambling mechanics.

COVID-19 Impact: Increased social isolation during the COVID-19 pandemic was associated with a rise in excessive gaming behaviours and related problems.

Future Treatment Directions

Personalised Medicine: Development of treatments tailored to individual risk factors and gaming patterns.

Technology-Based Interventions: Potential use of apps and digital tools to help manage gaming habits.

Family-Based Approaches: Development of comprehensive family therapy approaches for gaming disorder.

Integrated Care Models: Comprehensive treatment approaches addressing gaming disorder alongside co-occurring conditions.

Policy and Regulatory Considerations

Game Industry Regulation

Design Element Regulation: Concerns about gambling-like mechanics in video games have led to calls for stronger regulation and safer game design practices.

Loot Box Regulation: Growing international concern about loot boxes and their similarity to gambling.

Age Restrictions: Consideration of age-appropriate gaming content and access restrictions.

Public Health Approaches

WHO Recognition: The inclusion of gaming disorder in ICD-11 provides a framework for public health responses.

Treatment Service Development: NHS model of specialised gaming disorder clinics provides a template for other healthcare systems.

Research Funding: Increased investment in gaming disorder research and prevention programs.

International Perspectives

WHO Leadership: The World Health Organisation's inclusion of gaming disorder in ICD-11 provides international recognition and framework.

UK Model: The NHS National Centre for Gaming Disorders represents a comprehensive public health approach.

Australian Research: Significant research contributions from Australian universities on prevalence and treatment.

Professional Resources and Training

Healthcare Provider Education

Recognition and Assessment: Training healthcare providers to recognise signs of gaming disorder and conduct appropriate assessments.

Treatment Approaches: Education about evidence-based treatments and when to refer to specialists.

Family Involvement: Understanding the importance of family education and support in treatment.

Specialised Training Programs

Gaming Disorder Expertise: Development of specialised training for mental health professionals working with gaming disorder.

Multidisciplinary Approaches: Training for teams including psychiatrists, psychologists, social workers, and family therapists.

Research Integration: Incorporating latest research findings into clinical practice.

Advocacy and Awareness

Reducing Stigma

Public Education: Increasing awareness that gaming disorder is a legitimate mental health condition requiring professional treatment.

Media Representation: Promoting accurate portrayals of gaming disorder and recovery stories.

Gaming Community Engagement: Working with gaming communities to promote healthy gaming practices.

Policy Advocacy

Treatment Access: Advocating for improved access to gaming disorder treatment services.

Research Funding: Promoting increased funding for gaming disorder research.

Game Industry Accountability: Advocating for responsible game design practices.

Community Engagement

Awareness Campaigns: Public awareness campaigns about gaming disorder and available resources.

School Programs: Educational programs for schools about healthy gaming habits and warning signs.

Family Support: Supporting the development of family education and support programs.

Conclusion

Internet Gaming Disorder (IGD), also known as Gaming Disorder, is a behavioural addiction characterised by impaired control over gaming, increasing priority given to gaming over other activities, and continued gaming despite harmful consequences. While gaming is a common and often healthy activity, excessive and uncontrolled gaming can significantly affect mental health, relationships, education, work, and overall wellbeing.

Important points to remember:

• Gaming disorder involves more than simply spending long hours gaming; the key issue is loss of control and functional impairment
• Symptoms may include preoccupation with gaming, withdrawal-like distress, tolerance, and neglect of daily responsibilities
• Excessive gaming can negatively affect sleep, academic or work performance, relationships, and physical and mental health
• Risk factors may include impulsivity, anxiety, depression, ADHD, social isolation, and the use of gaming as a coping mechanism
• Modern game design features, including reward systems and social engagement mechanics, may increase the risk of problematic gaming behaviours
• Effective treatment often includes cognitive behavioural therapy (CBT), family support, healthy routine development, and management of co-occurring mental health conditions
• Early recognition, balanced gaming habits, and supportive intervention can help prevent more severe impairment
• With appropriate support, individuals can regain balance, improve daily functioning, and maintain healthier relationships with gaming and other areas of life

Overall, Internet Gaming Disorder is a complex but treatable condition that requires balanced understanding, early intervention, and supportive, evidence-based care.

References