What is Internet Gaming Disorder?

IGD is characterised by persistent, compulsive gaming behaviour (online or offline) that continues despite negative consequences. It is currently listed in the DSM-5 as a condition for further study and recognised by WHO as Gaming Disorder in ICD-11 when behaviour patterns are severe and long-standing.

Core features / diagnostic indicators (common criteria)

• Preoccupation with gaming.
• Withdrawal symptoms when gaming is taken away (irritability, moodiness).
• Tolerance (need to spend increasing time gaming).
• Unsuccessful attempts to control gaming.
• Loss of interest in previous hobbies and entertainment.
• Continued excessive use despite problems (academic, occupational, social).
• Deception of family members, therapists or others regarding gaming.
• Use of gaming to escape or relieve negative moods.
• Jeopardising/losing relationships, job, education due to gaming.

Severity is judged by functional impairment and duration — usually several months of patterned behaviour.

Risk factors

• Younger age (adolescents, young adults).
• Existing mental health issues (depression, anxiety, ADHD).
• Social isolation or poor family support.
• Personality traits: impulsivity, sensation-seeking.
• Easy access to high-engagement games and devices.
• Poor sleep hygiene and irregular schedules.

Assessment — practical steps

1. Functional impact: Ask about school/work performance, sleep, hygiene, nutrition, relationships and legal/financial consequences.
2. Screening tools: Internet Gaming Disorder Scale (IGDS), Gaming Addiction Scale — use as adjuncts, not replacements for clinical interview.
3. Timeline mapping: Map onset, escalation patterns, triggers, and attempts to cut down.
4. Comorbidity screen: Assess for depression, anxiety, ADHD, substance use and suicidality.
5. Collateral information: Speak with family/schools/employers with consent to clarify impact and safety.

Differential diagnosis

• Primary mood or anxiety disorders where gaming is an avoidance strategy.
• ADHD — inattention/impulsivity may present as excessive gaming.
• Autism spectrum — special interests can include gaming without necessarily being disordered.
• Substance-related addictive behaviours — consider overlapping mechanisms.

Evidence-based treatments

High-quality evidence is emerging; best practice borrows from addiction and behavioural therapies, combined with family and educational interventions.

1. Cognitive-Behavioural Therapy (CBT)

• Core approach: identify triggers, challenge maladaptive beliefs (e.g., “I can only feel competent in-game”), develop alternative activities and coping skills.
• Use behavioural experiments, activity scheduling, stimulus control (device limits), and relapse prevention techniques.

2. Motivational Interviewing (MI)

• Useful for ambivalent clients — builds motivation for change and sets personalised goals.

3. Family-based interventions

• Important for adolescents: set clear limits, consistent routines, joint problem solving, communication skills and shared goals.
• Parent management training helps set boundaries without escalating conflict.

4. Group therapy & peer support

• Provides social connection, accountability and modelling of healthy habits.

5. Psychiatric medication (adjunctive)

• No medication is approved specifically for IGD. Treat comorbid conditions (SSRIs for depression/anxiety, stimulants for ADHD) when present — which may reduce gaming-driven avoidance.

6. Digital / stepped-care interventions

• Guided online CBT programs, apps that monitor/limit playtime, and teletherapy can be effective as part of stepped care.

Practical treatment plan template (brief)

1. Engagement & assessment — build rapport, set collaborative goals.
2. Motivational work — explore pros/cons of gaming behaviour.
3. Structure & skills — daily routine, sleep schedule, replace gaming with meaningful alternatives.
4. Behavioural strategies — device curfews, app/timer restrictions, gradual reduction plan if abrupt stop causes distress.
5. Family work — agreements, positive reinforcement, remove enabling patterns.
6. Relapse prevention — identify triggers, early warning signs, coping plans.

Prevention & harm-reduction

• Promote balanced screen time and active hobbies from early childhood.
• Educate families about game mechanics designed to maximise engagement (loot boxes, reward schedules).
• Encourage good sleep hygiene and regular physical activity.
• School-based programs that teach self-regulation and digital literacy.

When to refer / red flags

• Severe functional impairment (dropout from school/work), self-neglect.
• Co-occurring severe depression, suicidal ideation or psychosis.
• Uncontrolled aggression, legal or financial harms linked to gaming.
• Resistance to any reduction with escalating family conflict or safety concerns.

Tips for parents & carers

• Respond calmly — avoid blaming or shaming.
• Negotiate limits together and involve the young person in solutions.
• Focus on rebuilding routines: sleep, meals, exercise and social contact.
• Model healthy screen habits and reward progress with non-screen activities.
• Seek professional help early if problems escalate.

Key takeaways

• IGD involves persistent gaming that causes significant impairment; evaluate functional impact, duration and comorbidity.
• CBT and family-based interventions are first-line; treat comorbid psychiatric disorders as needed.
• Prevention through education, balanced routines and parental guidance reduces risk.
• Use a stepped-care approach: brief interventions, guided digital tools, outpatient therapy, and specialist referral when necessary.