The DSM-5 work group reviewed more than 240 articles and found some behavioral similarities of Internet gaming to gambling disorder and to substance use disorders. The literature suffers, however, from lack of a standard definition from which to derive prev- alence data. An understanding of the natural histories of cases, with or without treatment, is also missing. The literature does describe many underlying similarities to substance ad- dictions, including aspects of tolerance, withdrawal, repeated unsuccessful attempts to cut back or quit, and impairment in normal functioning. Further, the seemingly high preva- lence rates, both in Asian countries and, to a lesser extent, in the West, justified inclusion of this disorder in Section III of DSM-S.
Internet gaming disorder has significant public health importance, and additional re- search may eventually lead to evidence that Internet gaming disorder (also commonly re- ferred to as Internet use disorder, Internet addiction, or gaming addiction) has merit as an independent disorder. As with gambling disorder, there should be epidemiological stud- ies to determine prevalence, clinical course, possible genetic inﬂuence, and potential bio- logical factors based on, for example, brain imaging data.
Internet gaming disorder is a pattern of excessive and prolonged Internet gaming that re- sults in a cluster of cognitive and behavioral symptoms, including progressive loss of control over gaming, tolerance, and withdrawal symptoms, analogous to the symptoms of sub- stance use disorders. As with substance-related disorders, individuals with Intemet gaming disorder continue to sit at a computer and engage in gaming activities despite neglect of other activities. They typically devote 8—10 hours or more per day to this activity and at least 30 hours per week. If they are prevented from using a computer and returning to the game, they become agitated and angry. They often go for long periods without food or sleep. Nor- mal obligations, such as school or work, or family obligations are neglected. This condition is separate from gambling disorder involving the Internet because money is not at risk.
The essential feature of Internet gaming disorder is persistent and recurrent participa- tion in computer gaming, typically group games, for many hours. These games involve competition between groups of players (often in different global regions, so that duration of play is encouraged by the time-zone independence) participating in complex structured activities that include a significant aspect of social interactions during play. Team aspects appear to be a key motivation. Attempts to direct the individual toward schoolwork or in- terpersonal activities are strongly resisted. Thus personal, family, or vocational pursuits are neglected. When individuals are asked, the major reasons given for using the com- puter are more likely to be ”avoiding boredom” rather than communicating or searching for information.
The description of criteria related to this condition is adapted from a study in China. Un- til the optimal criteria and threshold for diagnosis are determined empirically, conserva- tive definitions ought to be used, such that diagnoses are considered for endorsement of five or more of nine criteria.
No consistent personality types associated with Internet gaming disorder have been iden- tified. Some authors describe associated diagnoses, such as depressive disorders, atten- tion-deficit/hyperactivity disorder (ADHD), or obsessive-compulsive disorder (OCD).
Individuals with compulsive Internet gaming have demonstrated brain activation in spe- cific regions triggered by exposure to the Internet game but not limited to reward system
The prevalence of Internet gaming disorder is unclear because of the varying question- naires, criteria and thresholds employed, but it seems to be highest in Asian countries and in male adolescents 12—20 years of age. There is an abundance of reports from Asian coun- tries, especially China and South Korea, but fewer from Europe and North America, from which prevalence estimates are highly variable. The point prevalence in adolescents (ages 15—19 years) in one Asian study using a threshold of five criteria was 8.4% for males and 4.5% for females.
Environmental. Computer availability with Internet connection allows access to the types of games with which Internet gaming disorder is most often associated.
Genetic and physiological. Adolescent males seem to be at greatest risk of developing