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Everything You Need to Know About (Internet) Gaming Disorder

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Sid Meier’s Civilization is an ongoing series of games that began in 1991, with the most recent entry, Civilization VI releasing in 2016.  Since its inception, it has gone down as one of the most addicting video games on the market. One player summarized his experience, claiming that it is the most addictive thing he has ever done.  He would play for up to ten hours at a time, without meaning to, and with everything else in his life taking a “back seat” to the game.  His efforts to get away from the game were mostly unsuccessful as well, stating that he has uninstalled the game several times, but has always come back to it, with the game consuming more and more of his time.

Whether facetious or serious, it encapsulates the problem that many people have experienced, both with Civilization, and other games over the years. As it has come to be known, this “One More Turn Syndrome” has even been embraced by the game’s developer.  Civilization Anonymous, a parody of a support group, with the tagline “You won’t stop playing until you want to stop playing,” was created in 2005 as a promotion for the newest version of the Civilization series (Civilization IV). They again continued with the joke in 2010 for the release of Civilization V.  The videos depict what many people would expect from Alcoholics Anonymous or other support groups.  A wife explains her husband’s experience of the addiction as, “When he had it bad he’d play 120, 130 turns at a time.  Days. Nights. All the time.” Later, an “addict” expresses:

“With me, it’s just an all-consuming addiction. We’d be sharing an intimate moment, and in my head, I’d be plotting new trade routes to Europe.  Or figuring a way to get native land at a discount… on my console, handheld, iPhone, iPad, and PC. My real life just didn’t matter to me anymore.”

While these sorts of stories may have been great for marketing, they echo some of the real tragedies other posters on the internet have shared.  In a thread titled “What’s the worst case of Video Game Addiction You’ve Witnessed” users shared their stories in hundreds of comments.  One person wrote about how World of Warcraft took over his life, leading him to have minimal contact with friends and family outside of the game, and caused him to gain 75 pounds of weight.  Another noted that he realized he had a problem when he identified that he felt closer to, and had more feelings for a character in a game than he had for any real person. Lastly, one user shared a story of a three-year-old girl dying of neglect in South Korea because her parents left her alone to go on a twelve-hour gaming binge at an internet cafe.

For some, the amount of time spent on games is a point of pride.  Most games have “achievements” that are unlocked as players progress through the game, or as they overcome difficult challenges.  On Xbox systems, this is summed up into the player’s overall “Gamerscore,” which is publicly visible on the player’s profile, while Playstation users accumulate bronze, silver, gold, and platinum trophies, as well as different “Trophy Levels” based on the total number across all games.  Individual players have reported putting thousands of hours into their games of choice – League of Legends, DOTA, World of Warcraft, Skyrim, Minecraft, Everquest, Team Fortress 2, Player Unknown’s Battleground (PUBG), and the exciting new game that nearly every teen and preteen is playing: Fortnight.  

For others, gaming is acknowledged as a guilty pleasure at best or a catastrophic addiction at worst.  Communities of gamers, and of parents have formed to try to address the negative effects of this Gaming Addiction, all while it has not actually been a valid diagnosis for clients.  Until now (sort of).


On June 18, 2018, the World Health Organization released the new International Classification of Diseases (ICD-11), and included within its pages is a new diagnosis – Gaming Disorder.  This inclusion, while not surprising given the surge in the popularity of video games in past years, it does come with a certain amount of controversy.  But, let’s start at the beginning.

The International Classification of Diseases is the Big Book of Diagnoses that your doctors, pediatricians, insurances, and sometimes therapists will use to diagnose and treat you.  The current version, the ICD-10, was released in 1996, and was adopted by the United States as of October 1, 2015 (yes, 19 years later!), and the ICD-11 is planned to come into effect on January 1, 2022.

Similarly, the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), or the Big Book of Mental Illness that your therapist will most likely be using, released on May 18, 2013, included the diagnosis of Internet Gaming Disorder as a “disorder warranting more research.” So while it’s not an official diagnosis at this point, more research into issues of Internet Gaming is encouraged.

Who Plays?

So who could be affected by this?  According to one study, 47% of adult men, and 39% of women reported “often or sometimes” playing video games.  These numbers skewed toward the younger end, with 60% of participates ages 18 to 29 reporting playing games, while 24% of adults 65 and older reported playing video games.

Research also suggests that about 1.6% of teens meet the criteria for Internet Gaming Disorder, with up to 5.1% being considered “at risk” of developing more severe symptoms.  If you’re reading this, odds are that you know someone, or several someones, that play games. Of course, this isn’t surprising! It’s a massively growing industry, with an estimated gross revenue of 137.9 billion dollars in 2018 across mobile (phones and tablets), PC, and console (Xbox, Playstation, etc.) games.  Whether it’s Candycrush, Angry Birds, Farmville, Clash of Clans, World of Warcraft, Call of Duty, or the new favorite of teens everywhere, Fortnight, it seems like everyone is playing something.  

With that bit of background information out of the way, let’s look at the specific symptoms of these  diagnoses:

Gaming Disorder is defined as a “pattern of gaming behavior” characterized by the following:

  • loss of control over the amount of time a person spends gaming,
  • giving an increasing level of importance to gaming over other activities and interest, with gaming taking precedence over all other interests and activities,
  • continuing to engage in increasing levels of gaming behaviors despite negative consequences (i.e., deteriorating relationships, grades, job performance, health, and weight problems, etc.)

And a person would meet the proposed criteria for Internet Gaming Disorder in the DSM-5 if they meet five or more of the following symptoms over a 12 month period:

  • Preoccupation with Internet games: thinking about previous gaming, or anticipating playing in the future; with Internet gaming becoming the dominant activity in daily life.
  • Withdrawal symptoms when Internet gaming is taken away: typically including irritability, anxiety or sadness
  • Tolerance: a need to spend increasing amounts of time engaged in Internet games.
  • Unsuccessful attempts to control his or her gaming
  • Loss of interest in previous hobbies and interests
  • Continued excessive use despite knowledge of problems that come from gaming
  • He/she has deceived others about the amount of time they spend gaming
  • The individual uses Internet games to escape or relieve a negative mood (i.e., sadness, guilt, anxiety)
  • The person has jeopardized or lost a significant relationship, job, or educational or career opportunity because of their gaming.


What Now?

Your son is staying up all night.  His grades are slipping. He quit the football team and his job.  Your daughter is withdrawing into her games. You never see her anymore, and even when you do you never talk.  She doesn’t spend time with her friends, except when online with them.

So What Do You Do Now?

Get Help for Yourself – There is only so much that I can cover in this post, but whether the addict is a child, a friend, a spouse, you need a group of people to support you through this time.  There are plenty of other resources, forums, and support groups online. For example:

Please note, neither Counseling Works nor I, am affiliated with these programs.  I have not vetted them in any way, and they are only provided as potential resources.  Please do your research before joining these communities, and mainly before paying for anything.

Get Help for the Addiction – While some people feel they are capable of handling the problem on their own, many need additional help.  Contact a therapist to discuss your concerns and to develop a plan to address the issue.

  • While traditional methods of treating addictions may be beneficial (i.e., abstinence or harm reduction), little specific research has been done on gaming addictions.  As of now, Cognitive Behavior Therapy (CBT) is typically recommended as a treatment.  CBT is focused on challenging and changing thoughts/beliefs/attitudes, as well as changing behaviors and teaching new skills to cope with the stressors that lead to the problematic thoughts and behaviors.  
  • Cam Adair, the founder of Game Quitters, advocates for at least a 90 day detox period where participants engage on no video game use and consume no media related to video games, including watching others play and reading about video games.  That 90 day period allows the gamer to engage in other hobbies and to make relationships with people outside of the gaming world.

Consider what other problems might be affecting the gamer.  Ask yourself what came first. It could be that the gaming is a symptom of other problems, rather than the cause, and addressing the deeper issues could improve the problematic gaming as well.

If you need more information or help in navigating these issues, I am here to help as well.  Please contact me if you or someone you care about is struggling with gaming, Internet, or other issues with technology.  Please call now to schedule an appointment, and we can talk about your concerns.


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