How is Gaming Addiction diagnosed? Is it in the DSM-5?

Key Points 

• Gaming addiction, or Internet Gaming Disorder (IGD) is included in the appendix of the DSM-5 as a potential diagnosis. The APA drafted diagnostic criteria for IGD, while indicating that additional research is warranted.

•  The World Health Organization (WHO) included Gaming Disorder in the ICD-11 and defines it as a pattern of digital or video gaming that significantly impaired one's ability to control their use, with an increase in priority of gaming over other activities and responsibilities.

• Video games nowadays can be incredibly addictive, with gameplay designed to incentivize engagement and continued play.  

• In this context, “gaming” refers to video games, but the term is also commonly used in the gambling industry (“responsible gaming”). However, the lines between gaming and gambling have blurred, with elements of some video games including gambling-like experiences and features.

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There is only one behavioral addiction that is currently included In the DSM-5: Gambling Disorder. Gaming addiction, or Internet Gaming Disorder (IGD), is included in a section that lists disorders that require further research. The American Psychiatric Association (APA) included IGD in the appendix of the DSM-5 as a potential diagnosis. Referring to the diagnostic criteria for substance use disorders, the DSM-5 drafted diagnostic criteria for IGD, while indicating that additional research is warranted.

“Gambling” and “gaming” are often used interchangeably in the gambling industry, with the term “responsible gaming” often being used to describe measures taken to encourage healthy betting and help reduce the chances of developing a gambling addiction. While drawing a clear distinction between gaming from gambling, this article aims to explore the impact of the addictive nature of video games specifically. 

Is Gaming Addiction real?

Gaming addiction, which is clinically referred to as “Internet Gaming Disorder” is a very real disorder that impacts millions of children, teens and adults alike. Recent data approximates that 2% of kids under the age of 18 in the United States meet the criteria for IGD based on behaviors defined in the 11th Revision of the International Classification of Diseases (ICD-11). Recent research suggests that video games are one of the most addictive technologies available today. 

How is Gaming Addiction diagnosed? Are there DSM-5 criteria? Is there a test? 

In the DSM-5, gaming addiction is not an official clinical diagnosis at this time, but is listed as a condition for which further research is recommended to better understand and diagnose it. The World Health Organization (WHO) included gaming disorder in the ICD-11 and defines it as a pattern of digital or video gaming that significantly impaired one's ability to control their use, with an increase in priority of gaming over other activities and responsibilities. This behavior escalates and does not cease, despite negative consequences resulting from compulsive gaming. 

The APA’s diagnostic criteria for Internet Gaming Disorder in the DSM-5 are based on the clinical factors for substance use disorders and involve endorsing five (or more) of the following nine criteria: 

1. Preoccupation with online/offline gaming 

2. Experience of unpleasant symptoms when gaming is taken away (i.e., withdrawal)

3. The need to spend increasing amounts of time engaged in games (i.e., tolerance)

4. Unsuccessful attempts to control participation in games (i.e., loss of control)

5. Loss of interest in previous hobbies and entertainment as a result of, and with the exception of games (i.e., give up other activities)

6. Continued excessive use of games despite knowledge of psychosocial problems (i.e., continuation)

7. Deceiving family members, therapists, or others regarding the amount of gaming (i.e., deception)

8. Use of games to escape or relieve negative moods (i.e., escape)

9. Jeopardizing or losing a significant relationship, job, or education or career opportunity because of participation in games (i.e., negative consequences)

Warning signs of Gaming Addiction

Warning signs of a video gaming addiction can include:

• Inability to stop or reduce gaming behavior

• Feelings of withdrawal when not gaming

• Needing to play more video games to experience the same fulfillment 

• Continuing to game despite negative consequences

• Gaming takes precedence over other responsibilities

• Isolating oneself in order to game

• Using gaming to reduce negative moods or feelings

• Lying about gaming behavior to others

• Video gaming negatively impacting physical and mental health or hygiene 

Potential causes of compulsive gaming

Research has not identified a singular cause of compulsive gaming but indicates that there are factors that may impact an individual's likelihood of developing a gaming addiction. A key differentiation in what may indicate a gaming addiction is if someone's use is passionate or pathological, meaning it stems from a place of illness or compulsion, and causes them distress. 

Studies have found that since the COVID-19 pandemic, instances of those seeking treatment for compulsive gaming has significantly increased and may be connected to other mental health challenges such as anxiety or depression. 

Treatment options for Gaming Addiction

Treatment for gaming addiction will depend on the severity of an individual's behaviors and what treatment they can access. Current research suggests that behavioral therapy techniques, such as Cognitive Behavioral Therapy (CBT) are effective methods to help reduce the behaviors associated with gaming addiction. Other interventions such as increased physical activity, specifically outdoor exercise and sports, can help reduce gaming addiction behaviors. 

Birches Health offers virtual therapy with professionals who are trained in techniques to treat gaming addiction. Virtual treatment allows individuals to receive support with greater flexibility and reduced barriers to specialized treatment for gaming addiction. 

You can speak with the Birches team at 833-483-3838 or email help@bircheshealth.com to connect today. Or if you’re ready for care now and want to book an appointment, simply click here to schedule one. 

Gaming Addiction Statistics

Limited research and the lack of formal recognition in the DSM-5 result in a wide range of potential individuals impacted by it. Studies suggest rates ranging from 1.7% to 10% of the population, with the majority of those who display behaviors of IGD to be between the ages of 18 to 34, with an average of 24 years old. A 2021 systematic review revealed that 3-4% of gamers worldwide were addicted to video games, meaning that there could be as many as 60 million people or more suffering globally.

Video games may impact the developing brain during adolescence and put them at a higher risk of developing a gaming addiction. 

Gaming and Gambling: Blurred lines with the “gamblification” of video games

A new convergence that all should be aware of is the intersection of gambling and online video gaming. We see this in the monetization of video games, in the flywheel mechanics of betting and in forms of wagering that often occurs in multiplayer online games that are explicitly targeted at 12-18 year olds. We also see this in the outright inclusion of casino based mini-games such as slot machines and roulette wheels inside of some video games.

As gaming and gambling converge online, two broad categories of examples of gambling within video games have emerged. The first is more obvious: in-game betting and wagering directly influenced by or imitating a real-life gambling experience. 

The second intersection of gambling and gaming is more subtle. And that’s what Birches Health founder Elliott Rapaport has referred to in presentations about this topic as the “gamblification” of video games. While gambling is often seen as more of a luck-based activity and video gaming a more skill-based one, there is overlap. We now regularly see chance-based systems within video games. This can include: 

• Free or earned currency with only in-game value

• Free or earned currency that encourages ongoing gameplay

• Monetization through gaming mechanics

• Points for items / gifts / currency

• “Freemium” models (e.g. optional purchases)

• Cosmetic items (example: “skins”)

• Required payment including entry fees, subscription models, or pay-to-play

The clinical signs of Gambling Disorder and Gaming Disorder also have significant similarities: preoccupation, withdrawal, tolerance built over time, loss of control, continued behavior despite consequences, lying and deception, risking important relationships and continuing despite it impacting other parts of life. It is evident that especially in younger demographics, there may be strong overlap between the signs of at-risk behaviors for gambling and gaming.

Worried about your or your child's video gaming behaviors? Reach out to Birches Health today by clicking here, calling 833-483-3838 or emailing help@bircheshealth.com.