Gaming Disorder

Gaming disorder is a behavioral addiction, which is much like a substance use disorder in terms of the characteristics and issues it causes. A behavior that produces a short-term reward—not including consuming a psychoactive substance like alcohol or a drug—can become addictive. A person has a behavioral addiction when he or she engages in the behavior persistently, in spite of problems it causes, and is no longer able to control the behavior.

Gaming can become addictive in this way.

When an individual plays video games or online games and develops characteristics of an addictive disorder, he or she may be diagnosed with internet gaming disorder. This may include loss of control over playing, spending a lot of time playing, gaming so much that other activities or responsibilities are neglected or ignored, and continuing to play even though it causes issues with health or in relationships with other people.

This behavioral addiction was only recently added to the International Classification of Diseases (ICD-11). The guide that lists all formally recognized human diseases provides three different types of gaming disorder. Gaming disorder, predominantly online is characterized by a focus on online games, while gaming disorder, predominantly offline includes any focus on gaming that is not online, such as standard video games. Gaming disorder, unspecified may include individuals who have characteristics of the disorder but don’t fit neatly into one of the other two types.

Playing a lot of internet or offline games does not necessarily mean someone has a video game addiction. But, experts in behavioral health are taking note of the real and risky potential of individuals becoming truly addicted to gaming.

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the manual used by many mental and behavioral health professionals to diagnose mental illnesses, does not list gaming disorder as an actual condition.
• The DSM-5 is the latest edition of this manual, and it does include internet gaming disorder as a potential condition that needs to be researched and investigated further before including it as a true disorder.
• Contrary to the DSM-5, the World Health Organization (WHO) decided to include gaming disorder in its most recent update of the ICD-11.
• Inclusion in the ICD-11 is important because this guide is used by countries around the world to implement public health policies.
• The WHO states that only a very small number of people who game struggle with gaming disorder. It suggests that individuals should watch for changes in behavior, health, and social functioning in gamers, as well as excessive gaming to the point of excluding other activities.
• Critics of formalizing gaming disorder as a true condition believe that research proving it is a real issue is problematic, that there is not enough consensus on symptoms, and that the listed symptoms rely too much on those of substance use disorders.
• Critics also believe inclusion of gaming disorder could lead to a panic about the harm of this activity and misdiagnoses and treatment.

The ICD-11 briefly describes the characteristics of gaming disorder and what must be observed in an individual to make a positive diagnosis:

• An inability to control gaming behaviors, for instance trying to play less but being unable to stop
• Gaming to the extent that other activities and responsibilities are neglected
• Continuing to game or even escalating duration and frequency of gaming despite the fact that doing so is causing negative consequences, such as poor health or difficulties in relationships

According to the ICD-11, these behaviors must be severe enough to significantly impair social, educational, personal, occupational, and other areas of functioning. The behaviors and impairment should be consistent for about 12 months in order to make a diagnosis, although they may be either episodic or continuous during that time period. If symptoms are severe, the 12-month period can be shortened for a diagnosis.

Although the DSM-5 does not yet recognize gaming disorder, it is important to be aware of this possible issue and to observe friends or family who game regularly. Some signs that there may be an issue with compulsive video gaming, regardless of whether or not gaming disorder can be officially diagnosed, include:

• Increasing frequency or duration of gaming
• Lying about how much time is spent on gaming
• Difficulty cutting back on gaming time
• Feelings of guilt or shame when unable to stop gaming
• Loss of interest in other activities
• Difficulties at work or school
• Anger, depression, or anxiety when not gaming
• Feeling calm again when back to games
• Thinking a lot about gaming
• Losing track of time when playing
• Changes in behavior, like sleep patterns, eating, personal hygiene
• Physical health problems, like headaches, fatigue, sore back or neck, weight gain, and carpal tunnel syndrome

There are no known causes of gaming disorder or other behavioral addictions, but there may be some common risk factors that make some people more susceptible. As with other addictions, family history and genetics seem to play a role. Those with a close family member who struggles with any type of behavioral addiction are more likely to develop one.

A study of hundreds of young gamers in South Korea, where gaming disorder is a bigger issue than in the west, found that there were several clear risk factors for developing an actual disorder: impulsivity, anxiety, spending more money on gaming, greater time spent on games during the week, and membership in gaming communities. Access is also important, as it is with substance abuse. Greater access to video or online games increases the risk that the games will be misused.

The studies linking gaming disorder to other mental, behavioral, or addictive conditions are limited. There is some evidence, though, that there are higher rates of substance use disorder in people with behavioral addictions. Specifically, as much as 38 percent of those who may have gaming disorder also struggle with substance abuse.

There may also be co-occurring mental illnesses with gaming disorder. Behavioral addictions in general may co-occur with depression, anxiety disorders, bipolar disorder, obsessive compulsive disorder, and attention deficit hyperactivity disorder, or ADHD.

As with any type of addiction, the prognosis for gaming disorder depends a lot on the individual. For those receptive to treatment and who want to make positive changes, the prognosis is very good. Individuals who cannot recognize that there are any issues with their behaviors, treatment will be more challenging and the outlook is less positive.

Because this condition is only newly recognized, research into best practices for treatment is limited. The type of therapy most studied is cognitive behavioral therapy (CBT), a typical approach for behavioral conditions. CBT can be useful in treating gaming disorder because it is a practical way of helping patients change negative thought and behavior patterns. Therapists practicing CBT help their patients become more aware of their actions and thoughts, set goals to change them, and use practical and action-based strategies to make real changes.

There are no medications that are used to treat gaming disorder, but many people with this condition may struggle with other mental illnesses that can be treated. Using therapy and medication to treat anxiety or depression, for instance, can help support therapy for managing gaming disorder.

Some patients with gaming disorder may benefit from residential treatment. A stay in a residential facility can allow the individual to focus on making changes while in a safe environment with no temptations. The type and duration of care that is best for each individual can be determined together with treatment professionals.

As gaming disorder gains more professional recognition, more people who struggle with gaming will be able to access professional treatment. For parents concerned about children and gaming, it is important to realize that most people who play games will not develop this condition. Keep limits and set boundaries for gaming and it is possible to have a healthy relationship with this recreational behavior.

We know that choosing the right treatment option for yourself or a loved one is difficult. We believe our unique model of care gives our clients the best chance at success.

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We offer clients the tools, skills, and support necessary to attain greater stability and independence with the confidence and courage to live a healthy, happy, and productive life.

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