Online gaming has become a ubiquitous form of entertainment, with a significant portion of the population engaging in video games regularly. The immersive and competitive nature of these games can be captivating, leading to questions about their potential for addiction. While the debate among researchers and health professionals continues, growing evidence suggests that video games can indeed be addictive for some individuals. This has led to the formal recognition and study of what is known as Internet Gaming Disorder.
Internet Gaming Disorder in the DSM-5-TR: A Diagnostic Perspective
The American Psychiatric Association (APA) acknowledges the seriousness of problematic gaming by including Internet Gaming Disorder (IGD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). The DSM-5-TR serves as a crucial guide for mental health professionals in diagnosing mental health conditions. It’s important to note that IGD is currently listed in a section requiring further research, alongside conditions like caffeine use disorder. This placement signifies that while recognized as a potential issue, more research is needed to fully understand and define it as a formal disorder.
Within the DSM-5-TR, IGD falls under the broader category of conditions being recommended for further study, in parallel to established substance-related addictive disorders such as those involving alcohol, tobacco, and opioids. Interestingly, Gambling Disorder is the only officially recognized behavioral addiction within the DSM-5-TR alongside substance use disorders, highlighting the evolving understanding of non-substance related addictive behaviors.
The DSM-5-TR emphasizes that for a pattern of gaming to be considered IGD, it must result in “significant impairment or distress” across multiple aspects of an individual’s life. Crucially, the proposed diagnostic criteria are specifically focused on internet gaming and do not encompass general internet use, online gambling, or excessive social media or smartphone use.
The DSM-5-TR outlines a set of proposed symptoms for Internet Gaming Disorder. These include:
- Preoccupation: An overwhelming focus and preoccupation with gaming becomes the central theme in daily life.
- Withdrawal: Experiencing withdrawal symptoms such as sadness, anxiety, or irritability when gaming is not possible or taken away.
- Tolerance: Developing tolerance, requiring increasingly more time spent gaming to achieve the same level of satisfaction or excitement.
- Loss of Control: Demonstrating an inability to reduce or stop gaming, despite repeated unsuccessful attempts to cut back.
- Sacrificing Other Activities: Giving up or losing interest in previously enjoyed hobbies and activities due to gaming.
- Continued Use Despite Consequences: Persisting in gaming despite recognizing and experiencing negative consequences in various life domains (e.g., relationships, work/school).
- Deception: Misleading family members, therapists, or others regarding the extent of gaming involvement.
- Mood Modification: Using gaming as a strategy to escape from or relieve negative moods, such as feelings of guilt, hopelessness, or anxiety.
- Risked Relationships/Opportunities: Jeopardizing or losing significant relationships, job opportunities, or educational/career advancements due to gaming.
According to the proposed DSM-5-TR criteria, a diagnosis of Internet Gaming Disorder necessitates the presence of five or more of these symptoms within a 12-month period. This condition can manifest through online gaming with others or in solitary gameplay.
International Classification of Gaming Disorder: The ICD-11 Perspective
The World Health Organization (WHO) has also addressed the issue of problematic gaming by including Gaming Disorder in the 11th Revision of the International Classification of Diseases (ICD-11). This inclusion by the WHO signifies a global recognition of gaming disorder as a health concern.
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 definition from the ICD-11 aligns closely with the DSM-5-TR in emphasizing impaired control, prioritizing gaming over other life aspects, and continued gaming despite negative repercussions. The ICD-11 definition reinforces the international consensus that problematic gaming is a legitimate concern requiring attention and understanding from healthcare professionals globally.
Ongoing Research and the Evolving Understanding of Gaming Disorder
The classification of internet gaming as an addiction or mental disorder remains a topic of considerable debate and an expanding field of research. Neurological studies are exploring the brain’s responses to video gaming, revealing similarities to the changes observed in substance addiction. These neurological parallels lend further weight to the argument for recognizing gaming disorder as a genuine addictive behavior.
A significant study published in the American Journal of Psychiatry in 2017 investigated the validity and reliability of the proposed DSM-5-TR criteria for Internet Gaming Disorder. The research aimed to compare IGD to gambling addiction and general problematic gaming behaviors, as well as to assess its impact on physical, social, and mental well-being. The findings indicated that while a large majority of individuals played video games, only a small percentage exhibited symptoms aligning with Internet Gaming Disorder.
This study, encompassing research across the U.S., UK, Canada, and Germany, found that over 86% of young adults (18-24) and more than 65% of all adults had recently engaged in online gaming. The study also noted a roughly equal participation rate between men and women. However, the research presented mixed results regarding whether individuals meeting IGD criteria experienced poorer overall health compared to those who did not.
The researchers estimated that approximately 0.3 to 1.0% of the general population might meet the criteria for a potential IGD diagnosis. They highlighted the crucial distinction between “passionate engagement” in gaming and “pathology.” The key differentiating factor may be whether an individual experiences distress related to their gaming habits. If gaming causes significant personal distress or impairment in life functioning, it moves beyond passionate engagement and may indicate a problematic pattern.
However, more recent research, including a 2022 cross-sectional study, suggests that the prevalence of IGD may be higher than initially estimated, particularly in comparison to other behavioral addictions. Numerous studies have also reported a significant increase in IGD incidence during the COVID-19 pandemic, potentially due to increased isolation and reliance on digital entertainment.
The ongoing research and discussions underscore the complexity of understanding gaming disorder. Some experts argue that excessive gaming might be a symptom of underlying mental health issues, such as depression or anxiety, rather than a primary disorder itself. Despite these debates within the professional community, personal accounts shared in the media highlight the real struggles and devastating consequences individuals and families face due to problematic gaming.
An article in the Proceedings of the National Academy of Sciences aptly summarizes the current dilemma: “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.” This statement encapsulates the delicate balance between providing necessary support and avoiding the over-medicalization of typical leisure activities.
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. These professionals can provide accurate assessment and recommend appropriate support or intervention strategies.
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
