Gaming

Video games are a source of fun, skill, friendship, and creativity for billions of people. Heavy play alone is not a disorder. Gaming becomes a concern when it takes control: when it crowds out sleep, school, work, and relationships, and continues even as those losses pile up.

ICD-11 includes gaming disorder under disorders due to addictive behaviours. DSM-5-TR lists internet gaming disorder as a condition needing further research rather than an official diagnosis. Most people who game do not have a disorder.

The WHO's ICD-11 describes gaming disorder as a pattern of gaming with impaired control, increasing priority over other interests and daily activities, and continuation or escalation despite negative consequences, severe enough to significantly impair personal, family, social, educational, or occupational functioning — normally evident for at least 12 months.¹

The WHO notes that studies suggest gaming disorder affects only a small proportion of people who play.¹ In the U.S., DSM-5-TR treats internet gaming disorder as a condition for further study, so clinicians may use different terms.

• Games can offer achievement, belonging, and escape that feel missing elsewhere.
• Design features — progression systems, daily rewards, and social obligations — encourage frequent, long play.
• Loneliness, anxiety, depression, and ADHD are common alongside problematic gaming.
• Loot boxes and in-game purchases with random rewards resemble gambling mechanics and can cause financial harm, especially for young people.

Like other rewarding activities, gaming engages the brain's reward-learning systems. Variable rewards — rare items, random drops — are particularly effective at sustaining play. These are the same principles explained in the behavior loop.

• Gaming may be the main place someone feels competent or connected.
• Stopping can mean letting down a team or losing progress.
• Gaming can be a way to avoid stress, conflict, or difficult feelings.

• Repeatedly playing much longer than planned
• Gaming taking priority over sleep, meals, school, work, or people
• Irritability or distress when unable to play
• Continuing despite clear harm, like failing classes or losing a job
• Spending money on in-game purchases that causes problems
• Losing interest in activities once enjoyed

Problems can include sleep loss, falling behind at school or work, conflict at home, isolation from offline relationships, physical inactivity, and money problems from in-game spending.

• Gamers often feel judged by people who do not understand games. Respect for the activity makes conversations easier.
• Gaming may be covering for depression or anxiety, which also need care.
• Taking a device away without a plan often leads to conflict rather than change.

• Track playtime honestly for a week.
• Set limits together (for families) or with yourself, and use built-in screen time tools.
• Keep consoles and phones out of the bedroom at night.
• Replace what gaming provides — connection, challenge, rest — with other activities.
• Disable or set spending limits on in-game purchases.

Cognitive behavioral therapy is the most studied approach for problematic gaming. Family-based approaches are often used with teens. Treating co-occurring conditions such as depression, anxiety, or ADHD is important.

1. Choose one change for today, such as no gaming after a set time.
2. Get a full night's sleep before deciding anything big.
3. If you feel hopeless or have thoughts of harming yourself, call or text 988.

• Show curiosity about the games before setting limits.
• Agree on clear, predictable rules rather than sudden bans.
• Watch for signs of depression, bullying, or anxiety behind the gaming.
• See supporting a child or teen.