Understanding Internet Gaming Disorder

Internet Gaming Disorder (IGD) is a behavioral condition characterized by excessive and compulsive use of online games that interferes with daily life, responsibilities, and relationships. Recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition warranting further study, IGD shares similarities with other addictive behaviors. Understanding its symptoms, causes, and potential treatments is essential for parents, educators, and healthcare providers concerned about the growing impact of digital gaming on mental health.

What is Internet Gaming Disorder?

Mental health professionals recognize Internet Gaming Disorder (IGD) as a behavioral condition characterized by excessive and compulsive engagement with online games. Although the term “gaming addiction” is often used in popular media, it is not a formal clinical diagnosis. Instead, “gaming addiction” typically refers to the psychological and behavioral patterns seen in individuals whose gaming habits significantly interfere with daily functioning, relationships, work, or school responsibilities ^[1].

IGD is currently listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition that requires further research before being formally classified as a diagnosable disorder. This inclusion reflects ongoing debate within the psychiatric community about whether problematic gaming behavior should be considered a distinct mental health condition or a symptom of underlying issues such as anxiety, depression, or ADHD. Nevertheless, concern about the growing impact of digital gaming has led to increased research and clinical attention worldwide ^[1].

DSM-5-TR Definition

Building on its initial mention in the DSM-5, Internet Gaming Disorder is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as a condition requiring further study. This classification reflects the need for additional research before IGD can be formally recognized as a standalone psychiatric disorder ^[1].

The DSM-5-TR, widely used by U.S. health professionals, is developed and regularly updated by a panel of international experts who review the latest scientific evidence to refine diagnostic criteria ^[2]. While the inclusion of IGD in this manual section does not yet grant it full diagnostic status, it acknowledges the growing clinical concern. It provides a framework for researchers and clinicians to better understand and study the condition. This evolving classification supports ongoing efforts to determine how excessive gaming impacts mental health and daily functioning.

ICD-11 Definition

In contrast to the DSM-5-TR’s more tentative classification, the International Classification of Diseases, 11th Revision (ICD-11), developed by the World Health Organization, officially recognizes gaming disorder as a diagnosable condition. This global manual is used by healthcare providers worldwide to guide clinical diagnoses and health reporting.

According to the ICD-11, gaming disorder is defined as “a pattern of behavior […] characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences ^[3].”

This definition highlights the behavioral nature of the disorder, focusing on functional impairment and compulsivity. While the DSM-5-TR calls for more research, the ICD-11’s formal recognition underscores growing international consensus on the potential harms of excessive gaming and the need for clinical awareness and intervention.

The Debate over the Diagnosis

While the DSM-5-TR currently classifies internet gaming disorder as a condition requiring further study, and the ICD-11 formally recognizes gaming disorder as a behavioral addiction, the broader mental health community remains divided over its classification.

Some researchers question whether the internet or digital gaming truly warrants recognition as a distinct psychiatric disorder. For example, a 2017 study evaluating the DSM-5’s proposed criteria found that only a small fraction of gamers would qualify for the diagnosis, and it failed to establish consistent links between gaming behavior and the kinds of adverse physical, social, or mental health outcomes typically associated with diagnosable disorders ^[4].

Conversely, more recent studies have documented individuals showing addiction-like symptoms, such as compulsive gaming, withdrawal, and significant life disruption, aligning gaming disorder more closely with other behavioral addictions ^[1][5]. Still, some experts argue that excessive gaming may be a symptom of underlying conditions like depression or anxiety, rather than a disorder in its own right.

Comparison to Gambling Addiction

The controversy surrounding internet gaming disorder often draws comparisons to gambling disorder, a formally recognized behavioral addiction in the DSM-5-TR. Gambling disorder involves persistent and recurrent gambling behavior that leads to significant impairment or distress, such as financial problems, relationship breakdowns, or psychological distress.

This comparison is particularly relevant because internet gaming and gambling share several behavioral and psychological traits. Both can involve reward-based reinforcement systems, impulsive decision-making, and the pursuit of psychological escape. Research shows that individuals with problematic gaming behaviors often exhibit similar traits to those with gambling addictions, including higher rates of mental health issues, such as anxiety or depression, and elevated levels of impulsivity ^[6][7].

Notably, while gaming and gambling share overlapping risk factors and demographic profiles, they are not always co-occurring. Most individuals diagnosed with one do not meet the criteria for the other, underscoring the importance of nuanced diagnosis and treatment approaches ^[6].

Understanding the warning signs of internet gaming disorder is key to recognizing when gaming shifts from a recreational activity to a potential mental health concern. While many people play video games without issue, some individuals develop patterns of behavior that mirror addiction.

Signs of Internet Gaming Disorder

Understanding the warning signs of internet gaming disorder is key to recognizing when gaming shifts from a recreational activity to a potential mental health concern. While many people play video games without issue, some individuals develop patterns of behavior that mirror addiction.

Symptoms of Internet Gaming Disorder

The DSM-5-TR outlines nine proposed symptoms for internet gaming disorder ^[1]:

• Preoccupation with gaming
• Feelings of sadness, anxiety, or irritability when unable to play
• Increasing the time spent gaming to achieve satisfaction
• Failed attempts to cut back or stop gaming
• Loss of interest in previously enjoyed activities
• Continued gaming despite negative consequences
• Lying about gaming habits
• Using gaming to cope with negative emotions
• Gaming that interferes with relationships, work, or school

A diagnosis typically requires five or more symptoms within 12 months ^[1].

Behavioral and Psychological Patterns

Beyond these core signs, individuals struggling with internet gaming disorder may also exhibit broader behavioral and emotional challenges ^[8], such as:

• Depressive symptoms like persistent sadness, social withdrawal, and lack of motivation
• Anxiety and emotional numbness
• Traits of neuroticism, including poor stress tolerance and frequent negative emotions
• Traits of psychoticism, such as impulsivity, aggression, or recklessness
  

These co-occurring symptoms do not automatically indicate a gaming disorder, as they may also be associated with other mental health conditions. However, they may point to a deeper issue requiring professional evaluation when they occur alongside compulsive gaming.

Causes of Internet Gaming Disorder

There is no single cause of internet gaming disorder. Like other behavioral addictions, it is a complex psychological condition influenced by a combination of factors, including individual vulnerabilities, environmental influences, and underlying mental health conditions.

Neurological Factors

The dopamine system is one of the most widely researched genetic influences on addiction. Dopamine is often called the brain’s ‘happy’ or ‘reward’ chemical, and most addictive activities cause a surge in dopamine levels, which fuels the desire for more. Subconscious fixation on the need for this chemical reward, often requiring increasing amounts of time spent on the addictive activity, is a key driver of addiction ^[9]. 

Genetic factors likely contribute to the level at which an individual responds to the effects of dopamine. Researchers have identified genes and environmental factors that influence whether altered dopamine responses are passed down from parent to child ^[9]. 

Personality Traits

​​Individuals with behavioral addictions, such as internet gaming disorder, often exhibit certain personality traits that may increase their vulnerability to problematic gaming behaviors. Common characteristics include high impulsivity, low self-control, sensation-seeking tendencies, and difficulty managing stress or negative emotions. These characteristics can make it harder to regulate gaming habits, primarily when gaming is used as a coping mechanism for emotional distress or life challenges ^[10].

Psychological Conditions

Certain mental health conditions are associated with a higher risk of developing behavioral addictions, including internet gaming disorder. These co-occurring conditions may either contribute to or result from excessive gaming behaviors. Commonly linked disorders include ^[10]:

• Gambling disorder
• Alcohol use disorder
• Other substance use disorders
• Antisocial personality disorder
• Depression
• Obsessive-compulsive disorder (OCD)
• Attention-deficit/hyperactivity disorder (ADHD)

Identifying and addressing these conditions is essential for effective treatment and long-term recovery.

Environmental Influences

Wider environmental and socio-cultural influences can significantly impact an individual’s disease experience. Several environmental factors are thought to increase the risk of internet gaming disorder ^[11]. These include: 

• Lack of social integration and school relationships
• Poor social skills development
• Bullying and victimization
• Lack of teacher or parental support
• High levels of gaming culture
• Increased stress and expectations
• Growth of international esports

These influences can contribute to excessive gaming as a coping mechanism or social outlet, particularly among vulnerable individuals.

Impacts of Internet Gaming Disorder

By definition, addiction disrupts normal functioning and prioritizes compulsive behavior over healthy responsibilities and social norms ^[12]. Internet gaming disorder is no exception, often undermining various areas of life, sometimes without the individual recognizing or acknowledging the harm.

• Relationships: Meaningful relationships, whether with friends, partners, or family, require emotional investment and time. When gaming becomes the central focus, it can lead to neglect, isolation, and weakened social bonds.
• Career and education: Excessive gaming often leads to missed work or school obligations, reduced productivity, and poor performance. Over time, this may result in disciplinary action, academic failure, or job loss.
• Physical health: Individuals may neglect hygiene, sleep, exercise, and nutrition, increasing their risk of illness and physical decline.
• Mental health: Persistent gaming is linked to heightened anxiety, depression, and emotional instability. Toxic gaming environments can expose players to cyberbullying, harassment, and stress.
• Financial stability: Time spent gaming can interfere with employment, and in-game purchases or microtransactions can result in substantial financial strain.

These impacts illustrate how internet gaming disorder can profoundly disrupt a person’s overall well-being. Recognizing these signs early and seeking appropriate support can help prevent long-term damage and promote healthier habits and recovery.

Diagnosing Internet Gaming Disorder

Diagnosing internet gaming disorder is a complex process that differs significantly from diagnosing physical illnesses. No definitive test, such as a blood panel or brain scan, can confirm the condition. Instead, diagnosis relies heavily on a comprehensive evaluation of the individual’s reported symptoms, behaviors, and functional impairments, typically conducted by a mental health professional.

Currently, internet gaming disorder is only partially recognized by healthcare systems, and a diagnosis often requires the expertise of a clinician familiar with behavioral addictions ^[1]. The process typically begins with a referral to psychiatric services, either by a general practitioner or through self-referral. A diagnostic interview is then conducted to evaluate symptoms and determine whether they align with the criteria for a psychiatric condition.

Additional assessments may be carried out to rule out other medical or psychological conditions that could explain the symptoms. Once a diagnosis is made, treatment options, such as therapy or medication, are tailored to the individual and monitored over time for effectiveness.

Internet Gaming Disorder Treatment

Treatment approaches for video game addiction are limited and currently rely on strategies adapted from other behavioral addictions. Cognitive-behavioral therapy (CBT) is widely used to help individuals recognize triggers and develop healthier coping mechanisms when reducing video game use. CBT is often combined with psychotherapy to address any psychological issues that may influence a person’s gaming disorder ^[13]. 

Family-focused interventions create a supportive recovery environment by addressing dysfunctional dynamics and improving communication. These approaches often integrate group therapy, mindfulness techniques, and structured programs like PIPATIC or GOT-TO-GO that emphasize collaborative goal-setting between patients and families ^[13]. 

Internet Gaming Disorder Prevention

Recognizing the signs of video game addiction can be challenging. While family members may notice the negative impacts of excessive gaming, they often feel unsure how to intervene effectively. Early support from a qualified mental health professional can be crucial in preventing problematic gaming from developing into a full addiction.

To help a young person who may be struggling with internet gaming behavior, consider the following strategies:

• Encourage self-awareness by helping them reflect on how gaming affects their daily life and overall well-being.
• Initiate open, non-judgmental conversations to express concern and invite dialogue.
• Stay curious and empathetic about their lived experiences and motivations for gaming.
• Ensure they are engaging with age-appropriate games and understand online safety practices.
• Collaborate with them to gradually reduce gaming time, using tools like in-game timers or agreed-upon stopping points.
• Introduce alternative hobbies or interests that can offer similar enjoyment and stimulation.
• Set shared family boundaries for the time spent accessing the internet or digital devices.

These supportive steps and professional guidance can make a meaningful difference in managing gaming-related challenges.

When to Seek Professional Help

Determining when video gaming shifts from a passionate hobby to a problematic addiction can be difficult. However, early intervention often leads to better outcomes for those affected. It may be time to seek professional support if gaming interferes with daily responsibilities, relationships, or mental health. Even if formal treatment isn’t required, healthcare providers can offer valuable insight and guidance.

Helpful resources for managing gaming addiction include:

• Speaking with a primary care physician for initial advice
• Requesting a referral to psychiatric or mental health services
• Contacting specialists experienced in treating internet gaming disorder

These resources can help individuals and families better understand the condition, develop coping strategies, and access appropriate treatment. Addressing concerns early improves outcomes and empowers individuals to regain control and build healthier relationships with gaming.

Final Thoughts

Internet gaming disorder’s multifaceted nature involves a complex interplay of genetic, psychological, and environmental factors. As gaming continues to evolve and become more embedded in everyday life, particularly among young people, it is essential to balance its benefits, such as social connection, stress relief, and cognitive engagement, with its potential risks. These risks include behavioral addiction, social isolation, and mental health challenges. 

To better support individuals affected by gaming disorder, continued research is needed to refine diagnostic criteria, develop effective treatment methods, and identify those most at risk. Education and early intervention are critical in helping individuals recognize problematic gaming behaviors before they escalate. Equally important is supporting open communication between families, schools, and healthcare professionals to ensure children and adolescents build healthy habits and digital literacy skills. By increasing awareness and reducing stigma, we can help individuals enjoy gaming as a positive outlet while minimizing the potential for harm.