Internet gaming disorder
Internet gaming disorder (IGD) has been met with controversy within the mental health community. A lot of the skepticism stems from how we view gaming. Video games are considered a fun distraction that millions of people do every day, not a source of potential addiction.
Summary
- Internet Gaming Disorder (IGD) is a behavioral addiction recognized by the ICD-11 but not yet officially classified as a disorder in the DSM-5, though evidence suggests it may be in future editions.
- Symptoms of IGD mirror other addictions, including impaired control over gaming, prioritization of gaming over responsibilities, and continued play despite negative consequences on work, school, and relationships.
- Causes of IGD are multifaceted, involving gaming design (compulsion loops and dopamine release), individual biological factors (family history of addiction, ADHD, anxiety), and environmental influences (family dysfunction, lack of parental monitoring).
- Treatment for IGD includes cognitive-behavioral therapy (CBT), medication, and group therapy, with approaches like ACRIP (CBT + mindfulness) and motivational enhancement therapy showing promising results in reducing gaming time and improving mental health. An EHR like TheraPlatform may help therapists organize and manage treatment plans.
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Regrettably, gaming isn’t a simple form of recreation for some. An increasing amount of evidence has shown the potentially damaging effects of unmanageable internet gaming. Here is what you need to know about internet gaming disorder.
What is Internet Gaming Disorder?
Gaming disorder is a behavioral addiction to internet gaming. The ICD-11 criteria are similar to other addictions and include the following components.
A persistent pattern of gaming behavior manifested by the following:
- Impaired control over gaming behavior. For example, people with gaming disorder will not be able to control the frequency, duration, and termination of their play.
- Gaming behavior takes precedence over other responsibilities and daily activities. For example, gaming is prioritized over work, school, and relationships.
- Continuation or escalation of gaming behavior despite negative consequences, including family conflict, poor work and school performance, isolation, and other negative impacts on health (e.g., forgetting to sleep or eat).
Other common symptoms related to gaming disorder are hiding game use, psychological withdrawal, loss of interest in different activities, and becoming angry when asked to stop.
The symptoms of gaming disorder are similar to other addictions. The key differentiating factor between gaming disorder and regular gaming is that the behavior must significantly impair functioning in social life, work, school, or family relationships.
Is gaming really a disorder?
While gaming is not yet recognized as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), it is listed in the International Classification of Diseases, 11th revision (ICD-11) as a “disorder due to substance use or addictive behaviour”, with an ICD-11 code of 6C51. The hesitation in calling gaming a disorder in the DSM appears to result from a concern over pathologizing gaming behavior. After all, there is a fine line between a passionate gamer and someone with a gaming disorder.
Currently, the DSM-5 recognizes internet gaming disorder as a “condition in need of further research.” However, with a large amount of building evidence, internet gaming disorder will almost surely be recognized as a full-fledged disorder in the next edition of the DSM.
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Causes of Internet Gaming Disorder
The causes of internet gaming disorder are numerous and multifaceted. That being said, here are some main features:
Gaming factors
- Although video game creators would never overtly admit it, video games are designed to be addictive. They operate according to a ‘compulsion loop’, where they continuously reward the player in-game and encourage them to continue through another cycle, which keeps them playing indefinitely.
- Video games activate the pleasure centers of the brain, causing the release of dopamine, which is highly reinforcing. Similar to developing tolerance to drugs, the brain becomes desensitized to dopamine, and more playing is needed to retain the same effect.
Individual factors
- Biology appears to play a large role in the development of gaming disorder. Family history of addiction and being male are connected with its occurrence. Further, dysfunction in dopaminergic brain systems is linked to gaming disorder, similar to other types of addiction.
- Gaming disorder possesses high comorbidity with generalized anxiety disorder (GAD) and attention-deficit hyperactivity disorder (ADHD).
- People who play video games for escapism—as opposed to recreation—are more likely to develop gaming disorder.
Environmental factors
- Dysfunctional family relationships—including lack of parental monitoring—are linked to the occurrence of gaming disorder.
- Strong peer groups and socialization have a protective effect on the development of gaming addiction.
For a more expansive explanation of potential causes, this journal article breaks it all down.
How do you diagnose Internet Gaming Disorder?
Besides solely relying on interpreting ICD-11 criteria, numerous measures have been developed to help assess addictive gaming behavior. Here are a few of the most relevant:
- The Gaming Addiction Scale-7 is one of the most popular and well-studied assessment measures of internet gaming. The main critique of the instrument is that its psychometric properties are not as robust as some others and doesn’t cover all the DSM and ICD-11 criteria.
- The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF) covers all DSM and ICD criteria but shows inconsistent reliability across different cultures.
- The Ten-Item Internet Gaming Disorder Test (IGDT-10) exhibits strong psychometric properties across cultures while encompassing ICD-11 criteria for the disorder.
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Treatment
Although treatment of gaming disorder is relatively new, the following interventions have been used:
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy is the most utilized type of treatment for gaming disorder. It is highly effective in improving symptoms of IGD, especially in the short term. Acceptance and cognitive restructuring intervention program (ACRIP) is an intervention that mixes CBT concepts with mindfulness meditation and has reduced symptoms of IGD and improved general well-being. Motivational enhancement therapy is another treatment that is often mixed with CBT to increase individuals’ motivation to stop addictive behaviors. The combined approach has been used successfully to decrease time spent playing video games and increase learning performance.
Group Therapy
Group therapy is a popular treatment option for addiction, offering support and motivation, along with theoretical interventions. One group therapy treatment that has been used effectively with gaming disorder is craving behavioral intervention or CBI. CBI is a cognitive-behavioral variation that focuses on coping methods to deal with cravings for internet gaming.
Medication
Antidepressant and ADHD medication are mostly used to treat IGD. Bupropion (Wellbutrin) has shown the most effectiveness overall. It has alleviated cravings for gaming, decreased time spent on the internet, and improved symptoms of depression. Methylphenidate (Ritalin) has also found success in decreasing time spent gaming and reducing the severity of symptoms.
Internet gaming disorder is a behavioral addiction that is gaining recognition as a serious problem within the gaming community. As a relatively new area of concern, the mental health community needs to initiate more research to further understand its etiology, assessment, and treatment.
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References
American Psychiatric Association. (2023, January). Internet Gaming. https://www.psychiatry.org/patients-families/internet-gaming
Deng, L. Y., Liu, L., Xia, C. C., Lan, J., Zhang, J. T., & Fang, X. Y. (2017). Craving Behavior Intervention in Ameliorating College Students' Internet Game Disorder: A Longitudinal Study. Frontiers in Psychology, 8, 526. https://doi.org/10.3389/fpsyg.2017.00526
Dittus, P. J., Li, J., Verlenden, J. V., Wilkins, N. J., Carman-McClanahan, M. N., Cavalier, Y., Mercado, M. C., Welder, L. E., Roehler, D. R., & Ethier, K. A. (2023). Parental Monitoring and Risk Behaviors and Experiences Among High School Students - Youth Risk Behavior Survey, United States, 2021. MMWR Supplements, 72(1), 37–44. https://doi.org/10.15585/mmwr.su7201a5
International Classification of Diseases, 11th Revision. (2024). 6C51 Gaming disorder. https://icd.who.int/dev11/l-m/en#!/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1448597234
Király, O., Koncz, P., Griffiths, M. D., & Demetrovics, Z. (2023). Gaming disorder: A summary of its characteristics and aetiology. Comprehensive Psychiatry, 122, 152376. https://doi.org/10.1016/j.comppsych.2023.152376
Kochuchakkalackal Kuriala, G., Reyes, M.E.S. Efficacy of the Acceptance and Cognitive Restructuring Intervention Program (ACRIP) on the Internet Gaming Disorder Symptoms of Selected Asian Adolescents. Journal of Technological and Behavioral Sciences, 5, 238–244 (2020). https://doi.org/10.1007/s41347-020-00132-z
Mohammad, S., Jan, R. A., & Alsaedi, S. L. (2023). Symptoms, Mechanisms, and Treatments of Video Game Addiction. Cureus, 15(3), e36957. https://doi.org/10.7759/cureus.36957
Song, J., Park, J. H., Han, D. H., Roh, S., Son, J. H., Choi, T. Y., Lee, H., Kim, T. H., & Lee, Y. S. (2016). Comparative study of the effects of bupropion and escitalopram on Internet gaming disorder. Psychiatry and clinical neurosciences, 70(11), 527–535. https://doi.org/10.1111/pcn.12429
Stevens, M. W. R., King, D. L., Dorstyn, D., & Delfabbro, P. H. (2019). Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis. Clinical psychology & psychotherapy, 26(2), 191–203. https://doi.org/10.1002/cpp.2341
Wang, Q., Ren, H., Long, J., Liu, Y., & Liu, T. (2019). Research progress and debates on gaming disorder. General psychiatry, 32(3), e100071. https://doi.org/10.1136/gpsych-2019-100071
Yarp, A. (June 3, 2024). VeryWell Health. What Is Internet Gaming Disorder (IGD)? https://www.verywellhealth.com/internet-gaming-disorder-5200375
Zajac, K., Ginley, M. K., & Chang, R. (2019). Treatments of internet gaming disorder: a systematic review of the evidence. Expert Review of Neurotherapeutics, 20(1), 85–93. https://doi.org/10.1080/14737175.2020.1671824
Zajac, Kristyn & Ginley, Meredith & Chang, Rocio & Petry, Nancy. (2017). Treatments for Internet Gaming Disorder and Internet Addiction: A Systematic Review. Psychology of Addictive Behaviors. 31. 10.1037/adb0000315.
