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Gaming Disorder

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Gaming Disorder, Internet Gaming Disorder, Excessive Video Games

  • See Also
  1. Digital Dependency
  2. Social Media Use in Adolescents
  • Epidemiology
  1. Video game play Prevalence: 205 Million (two thirds of U.S population)
    1. Up to 50% of those who game, report problematic use
  • Pathophysiology
  1. Video game play has positive benefits in moderation
    1. Recreational gaming can connect players with family and friends
    2. May increase socialization and increase interpersonal relationships
    3. May give temporary respite to more stressful external experiences
    4. May improve cognitive processing, juggling tasks and in some cases offer education
  2. Excessive gaming has adverse effects
    1. Dependence and addiction at the expense of relationships and responsibilities
    2. Altered neurobiological pathways during development (childhood and teen years)
    3. Increased craving of video game stimulation diverts attention from reality
    4. Associated with poor academic performance and poor grades
    5. Adverse mental health effects, including Insomnia, Major Depression and Suicidal Ideation
    6. Associated with unhealthy habits (poor diet, lack of Exercise, poor hygiene) and Obesity
  • Risk Factors
  1. Adolescents (extending into young adulthood)
  2. Attention-deficit hyperactivity disorder
  3. Mood Disorders (Major Depression, Anxiety Disorder)
  4. Developmental Disability
  • Diagnosis
  • Gaming Disorder
  1. Causes significant Impairment in patient's life
  2. Criteria (2 of 3 criteria for at least 12 months)
    1. Impaired control over gaming (onset, frequency and intensity)
    2. Increased priority given to gaming (takes precedence over other life interests, daily activities)
    3. Continuation or escalation of gaming despite negative consequences
  • Diagnosis
  • Internet Gaming Disorder
  1. Causes significant Impairment in patient's life
  2. Criteria (5 of 9 criteria for at least 12 months)
    1. Salience
      1. Thinking about previous gaming activity
      2. Anticipating playing the next game
    2. Gaming tolerance
      1. Increased hours spent gaming
    3. Mood modification
      1. Gaming used to escape or relieve negative mood (e.g. guilt, anxiety)
    4. Relapse
      1. Unsuccessful attempts to stop or reduce gaming time
    5. Withdrawal symptoms
      1. Irritability or anxiety when games are removed
    6. Conflict
      1. Loss of interest in real life relationships, hobbies, Physical Activity or other entertainment
    7. Deception
      1. Deception of gaming activities to family, therapists and others
    8. Problems
      1. Continued excessive gaming despite knowledge of negative consequences
    9. Lost opportunities
      1. Jeopardized or lost relationships, jobs, education or career opportunities due to gaming
  • Evaluation
  1. Screen for Digital Dependency and Gaming Disorder at routine visits
    1. See Adolescent Health
  • Management
  1. Manage comorbid mental health and lifestyle concerns
  2. Consider social support groups
  3. Consider formal mental health specialist referral (e.g. Cognitive Behavioral Therapy)
    1. Acute distress (esp. with comorbid mental health conditions)
    2. Refractory course
  4. Motivational Interviewing
    1. See Motivational Interviewing (Five Rs Technique)
    2. Relevance
      1. How many hours a day do you spend gaming?
      2. What types of games do you play?
    3. Risks
      1. Are you aware of your gaming addiction?
      2. Have you had problems because of your gaming (e.g. school grades, work performance)?
    4. Rewards
      1. Why do you enjoy playing video games?
    5. Roadblocks
      1. Are you motivated to make a change?
      2. What life stressors do you have currently that would prevent change?
    6. Repeat
      1. Readdress at each visit with an unmotivated patient
  • Prevention
  1. See Digital Dependency
  2. See Social Media Use in Adolescents
  3. Discuss complications of Gaming Disorder and Internet Gaming Disorder
  4. Family Media Plan
    1. See Digital Dependency for age specific guidelines
    2. Consistent guidelines for gaming and media across all household members (including parents)
    3. Limit recreational Screen Time to <1-2 hours/day
    4. Promote alternative activities (e.g. social activities, Exercise and sports)
    5. Emphasize future goals and academics
  5. Take breaks from gaming
    1. Physical Activity
    2. Relieve Dry Eyes and eye strain
    3. Social interaction
  • Complications
  1. Mental health disorders (e.g. Mood Disorders, Suicidality)
  2. Poor school performance and poor grades
  3. Lack of social skill development
  4. Unhealthy lifestyle and Obesity Risk
  5. Insomnia
  6. Dry Eyes
  • Resources
  • Game Ratings for Violence and other problematic themes
  1. Entertainment Software Rating Board (ESRB)
    1. https://www.esrb.org/
  2. Nintendo Switch Parental Controls
    1. https://www.nintendo.com/au/apps/parental-controls/
  3. Playstation Family Account Setup
    1. https://www.playstation.com/en-us/support/account/playstation-family-account-set-up/
  4. Steam Families User Guide
    1. https://help.steampowered.com/en/faqs/view/054C-3167-DD7F-49D4
  • References
  1. (2013) DSM5, APA
  2. King (2020) Clin Psychol Rev 77:101831 +PMID: 32143109 [PubMed]
  3. Shi (2025) Am Fam Physician 112(5): 555-57 [PubMed]