Level Up or Log Off? Understanding Gaming Disorder

To level up or to log off, that is the question constantly faced by those passionate about video games. The alarming rise of gaming disorder demands gamers and health professionals alike to evaluate: when does a harmless hobby become a serious addiction? 

 Video games first gained traction in the 70s with the availability of arcade, console, and PC games. The popularity of video games rose along with the internet, which enabled multiplayer gaming. Now, with the boom in social media and mobile devices, online video games are more accessible than ever before. There are over 3 billion video game consumers globally, which covers about 40% of the world’s population¹. Among them, the majority of about 48% are PC game consumers. For most people, gaming is a pastime that is not just entertaining but also rewarding; often a way to unwind after the daily grind. This rewarding nature is what may make one vulnerable to addiction to video games.  

 Gaming disorder is characterised by persistent gaming that has major negative impacts on daily life². It involves a loss of control over gaming habits, prioritisation of gaming despite facing negative consequences, and withdrawal symptoms such as anxiety. The diagnostic criteria also state that such patterns are present for over 12 months, which results in significant distress or impairment in vital areas of functioning. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) has included internet gaming disorder as a condition that requires further research, gaming disorder was recognized as a diagnosable addictive behaviour disorder by WHO’s International Classification of Diseased (ICD-11) in 2018³. This signifies a growing importance given to addressing the potentially harmful effects of video games on individuals and society.  

 One such individual affected by gaming disorder is Aditya, a boy in his early-teens who is a part of the new generation of mobile gamers that was produced by the Covid-19 pandemic³. When his school started online classes upon lockdown, he got unlimited access to devices for his studies. Whereas previously, his screentime has been limited to a couple hours of gaming in the evenings. He learned to use chat GPT to keep up the façade that he was doing well academically, but like many of his peers, Aditya would spend far more time gaming than paying attention to class or doing assignments. Excessive gaming led to his sleeping and eating patterns being dysregulated. He did not want to socialise with anyone other than his group of online friends who played an online game as a team. He also lost interest in all other activities.    

 After the pandemic restrictions lifted and in-person schooling resumed, Aditya was forced to cut his gaming hours short, wake up early in the morning, and study without the internet at his disposal. Most of his gaming team except one member stopped gaming to focus on school and work, but Aditya was not able to give it up and continued to play games all night. His lack of sleep exacerbated his difficulties in his studies. He grew irritable and had frequent anger outbursts. He experienced an incident at school where he felt humiliated and turned to his only remaining online friend for companionship. He got further reliant on gaming for instant gratification, involving achievement, inclusion, and entertainment that he lacked in other aspects of his life⁴. Due to family circumstances, Aditya moved to another town and changed schools, where he had trouble adjusting due to his existing issues. He soon refused to go to school and did not comply to his parents whatsoever. The parents then took Aditya to a mental health clinic where he was diagnosed with gaming disorder, prescribed medication, and kept engaged in regular counselling sessions. After around two months of treatment, there was an improvement in his condition, and he was able to regulate his mood, daily functioning, and schooling.  

 The case of Aditya is one story among many whose gaming habits developed into a serious mental health condition. Although estimates of the prevalence of gaming disorders vary due to differences in screening criteria, the prevalence is found to be comparable to obsessive-compulsive disorder and some substance-related addictions⁵. While one meta-analysis found that 3.05% of the global population suffer from gaming disorder, another found a prevalence of 9.9%; with 8.8% among adolescents and 10.4% among young adults ^5,6. In a research among Nepali young adults, 4.7% of respondents reported significant problems due to internet use⁷. Different studies on gaming disorder among Nepali youth have estimated the prevalence to be from 7.1% to 18.9%^8,9.  

 Gaming disorder warrants greater recognition and preventative efforts by health professionals, educators, guardians, and consumers of video games as well. While further research is ongoing, existing evidence points to negative consequences of excessive gaming such as functional impairment, social isolation, and mood disorders like depression¹⁰. Such effects can be mitigated by promoting digital literacy, healthy device use habits, and accessible mental health services. Lastly, it is also important to prevent the stigmatization of video games and those struggling with gaming disorder to establish a nuanced view of gaming behaviours¹¹. 

References 

1. Bankhurst A. Three Billion People Worldwide Now Play Video Games, New Report Shows. IGN [Internet]. 2020 Aug 15; Available from: https://www.ign.com/articles/three-billion-people-worldwide-now-play-video-games-new-report-shows
2. ICD-11 for Mortality and Morbidity Statistics [Internet]. [cited 2024 Apr 29]. Available from: https://icd.who.int/browse/2024-01/mms/en#1448597234
3. Internet Gaming [Internet]. [cited 2024 Apr 30]. Available from: https://www.psychiatry.org:443/patients-families/internet-gaming
4. Zhou SX, Leung L. Gratification, Loneliness, Leisure Boredom, and Self-Esteem as Predictors of SNS-Game Addiction and Usage Pattern Among Chinese College Students. Int J Cyber Behav Psychol Learn IJCBPL. 2012 Oct 1;2(4):34–48.
5. Stevens MW, Dorstyn D, Delfabbro PH, King DL. Global prevalence of gaming disorder: A systematic review and meta-analysis. Aust N Z J Psychiatry. 2021 Jun;55(6):553–68.
6. Gao YX, Wang JY, Dong GH. The prevalence and possible risk factors of internet gaming disorder among adolescents and young adults: Systematic reviews and meta-analyses. J Psychiatr Res. 2022 Oct 1;154:35–43.
7. Paudel L, Sharma P, Kadel AR, Lakhey K, Singh S, Khanal P et al. Association Between Internet Addiction, Depression and Sleep Quality Among Undergraduate Students of Medical and Allied Sciences. 2021 [cited 2024 Apr 30]; Available from: http://elibrary.nhrc.gov.np:8080/handle/20.500.14356/1152
8. Shahi S, Raj Y, Mishra DK. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study. Int J Occup Saf Health. 2023 Jan 1;13(1):1.
9. Shrestha R, Priyanka J, Gyanwali B, Banjade S, Jyakhwo S. Factors Associated with Prevalence of Internet Gaming Disorder among School Going Adolescence of Butwal, Nepal. One Health J Nepal. 2023 Jul 28;3:24–8.
10. Petry NM, Rehbein F, Ko CH, O’Brien CP. Internet Gaming Disorder in the DSM-5. Curr Psychiatry Rep. 2015 Jul 29;17(9):72.
11. Kuss DJ, Griffiths MD, Pontes HM. DSM-5 diagnosis of Internet Gaming Disorder: Some ways forward in overcoming issues and concerns in the gaming studies field. J Behav Addict. 6(2):133–41.