Online games have become a ubiquitous form of entertainment, with a significant portion of households engaging in video games. Millions of adults immerse themselves in internet-based gaming, drawn to the entertainment and competitive aspects. However, the question of whether this popular pastime can become addictive is a subject of ongoing discussion among experts. Emerging evidence suggests that video games can indeed be highly engaging, and research is actively exploring effective approaches to understand and address potential gaming addiction.
Internet Gaming Disorder in the DSM-5-TR: Defining the Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a critical resource used by mental health professionals, addresses the concept of gaming addiction. Within the DSM-5-TR, this condition is termed Internet Gaming Disorder (IGD)(1). It’s important to note that IGD is currently categorized in a section designated for conditions needing further research, alongside areas like caffeine use disorder.
The DSM-5-TR already includes substance-related addictive disorders, such as those involving alcohol, tobacco, stimulants, marijuana, and opioids. Intriguingly, Gambling disorder is currently the sole behavioral addiction recognized within the DSM-5-TR framework, distinguishing it from addictions centered around substance use.
For IGD to be considered, the DSM-5-TR specifies that it must lead to “significant impairment or distress” across multiple areas of an individual’s life. Crucially, this proposed condition is specific to gaming and does not encompass broader issues related to general internet use, online gambling, or excessive social media or smartphone usage. The proposed symptoms that define internet gaming disorder include:
- Gaming Preoccupation: An overwhelming focus on gaming becomes the central point of thought and life.
- Withdrawal Symptoms: Experiencing negative emotional states like sadness, anxiety, or irritability when gaming is unavailable or restricted.
- Tolerance: A growing need to increase gaming time to achieve the desired level of satisfaction or excitement.
- Impaired Control: Repeated unsuccessful attempts to reduce or stop gaming, indicating a loss of control over the behavior.
- Sacrificing Other Interests: Giving up previously enjoyed hobbies, social activities, or other interests due to an increasing focus on gaming.
- Continued Gaming Despite Problems: Persisting with gaming despite recognizing and experiencing negative consequences in various life domains.
- Deception: Misleading family members, friends, or others about the actual amount of time spent gaming to conceal the extent of involvement.
- Mood Modification: Using gaming as a coping mechanism to escape from or relieve negative moods, such as feelings of guilt, hopelessness, or anxiety.
- Risked Relationships or Opportunities: Jeopardizing or losing significant relationships, employment, education, or career opportunities due to excessive gaming.
According to the proposed diagnostic guidelines, an individual would need to exhibit five or more of these symptoms within a 12-month period to potentially warrant a diagnosis of internet gaming disorder. This condition can manifest in both online multiplayer gaming and solitary gaming experiences.
Global Perspectives: ICD-11 and the International Classification
The World Health Organization (WHO) has also recognized the significance of problematic gaming behavior, including gaming disorder in the 11th Revision of the International Classification of Diseases (ICD-11)(2). The ICD-11 defines gaming disorder as “a pattern of gaming behavior (‘digital-gaming’ or ‘video-gaming’) 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.” This international consensus highlights the growing recognition of gaming disorder as a potential health concern globally.
The Ongoing Research: Unraveling the Complexities of Gaming and Addiction
The classification of internet gaming as an addiction or mental disorder remains an active area of research and debate within the scientific community. Neurological studies are exploring potential parallels in brain changes between individuals with video game engagement and those with substance use disorders. This research aims to shed light on the underlying mechanisms and similarities in addictive behaviors.
A study published in the American Journal of Psychiatry in 2017 investigated the validity and reliability of the DSM-5 criteria for internet gaming disorder, comparing it to existing research on gambling addiction and problematic gaming. The study also aimed to assess the potential impact of IGD on physical, social, and mental well-being(3). The findings indicated that while a vast majority of gamers do not exhibit symptoms of internet gaming disorder, a small percentage might meet the criteria for diagnosis.
This research encompassed multiple studies involving adults in the U.S., United Kingdom, Canada, and Germany. The study revealed that a significant proportion of young adults (18-24 years) and adults overall had recently engaged in online gaming. While the rates of recent gaming were similar between men and women, the research presented mixed results regarding whether those meeting IGD criteria experienced poorer health outcomes compared to those who did not.
The researchers estimated that a small percentage of the general population, ranging from 0.3 to 1.0 percent, might potentially qualify for a diagnosis of internet gaming disorder. They emphasized the critical distinction between passionate engagement in gaming and pathological gaming behavior indicative of a disorder. The key differentiator, they suggested, might be whether an individual experiences distress or negative impacts related to their gaming habits.
However, more recent studies, including a 2022 cross-sectional study, suggest that the prevalence of IGD could be higher than previously estimated, particularly when compared to other behavioral addictions.(4) Furthermore, several studies have reported a significant increase in IGD incidence during the COVID-19 pandemic, potentially linked to increased isolation and reliance on digital entertainment.
The research landscape and scholarly debate continue to evolve. Some researchers propose that excessive gaming might be a symptom of underlying mental health conditions like depression or anxiety, rather than a primary disorder itself. Despite the ongoing professional discussions, personal accounts and media reports highlight the real-world struggles and detrimental consequences experienced by individuals and families affected by problematic gaming.
A feature in the Proceedings of the National Academy of Sciences aptly summarizes the ongoing discussion: “Adding video gaming to the list of recognized behavioral addictions could help millions in need. It could also pathologize a normal behavior and create a new stigma.”(5) This highlights the delicate balance between recognizing and addressing genuine gaming-related problems while avoiding the over-pathologization of a common leisure activity.
If you have concerns about your own gaming habits or those of someone you know, seeking guidance from a healthcare provider or a mental health professional is a crucial step. They can offer personalized assessment and support in navigating the complexities of gaming and potential addiction.
Physician Review
James Sherer, M.D.
January 2023
References
- American Psychiatric Association. 2022. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. American Psychiatric Association Publishing
- World Health Organizations. (n.d.). Gaming disorder. Gaming disorder (who.int)
- Przybylski, A. K., Weinstein, N., & Murayama, K. (2017). Internet Gaming Disorder: Investigating the Clinical Relevance of a New Phenomenon. The American Journal of Psychiatry, 174(3), 230–236. https://doi.org/10.1176/appi.ajp.2016.16020224
- Gao, Y. X., Wang, J. Y., & Dong, G. H. (2022). The prevalence and possible risk factors of internet gaming disorder among adolescents and young adults: Systematic reviews and meta-analyses. Journal of psychiatric research, 154, 35–43. https://doi.org/10.1016/j.jpsychires.2022.06.049
- Zastrow M. (2017). News Feature: Is video game addiction really an addiction?. Proceedings of the National Academy of Sciences of the United States of America, 114(17), 4268–4272. https://doi.org/10.1073/pnas.1705077114
