Video Game Addiction: Signs, Risk Factors, and ADHD Links

By Jeremy Edge, LPC, IGDC June 5, 2024

Video game addiction – also known as gaming disorder and Internet gaming disorder – is a real but treatable condition. It also frequently occurs alongside ADHD. Learn the signs of gaming addiction and what researchers have learned about problematic and disordered gaming, along with available treatments and resources.

Of the billions of people worldwide who play video games, a very small subset exhibits disordered, out-of-control behaviors wherein gaming vastly impacts functioning and interferes with important aspects of living. Video game addiction – also known as “gaming disorder” and “internet gaming disorder”  is rare, but it does happen.

While research on video game addiction is just beginning to blossom, scientists have revealed a few key insights – like the fact that attention deficit hyperactivity disorder (ADHD) is a risk factor for video game addiction. Several treatments for gaming disorder are already available, as are interventions for individuals who display at-risk and problematic gaming behaviors.

Video Game Addiction Symptoms

In the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11), video game addiction is recognized as “gaming disorder.” In the U.S., “Internet gaming disorder” (IGD) appears as a proposed condition under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) that warrants further research.

As described in the ICD-11 and DSM-5-TR, video game addiction is characterized by persistent patterns of excessive gaming that result in loss of control and adverse consequences over many aspects of a person’s life.

Gaming Disorder Symptoms (ICD-11)

Internet Gaming Disorder Symptoms (DSM-5-TR)

Essential (Required) Features impaired control over gaming behavior (e.g., onset, frequency, intensity, duration, termination, context) increasing priority given to gaming behavior to the extent that gaming takes precedence over other life interests and daily activities continuation or escalation of gaming behavior despite negative consequences (e.g., family conflict due to gaming behavior, poor scholastic performance, negative impact on health) The pattern of gaming behavior may be continuous or episodic and recurrent but is manifested over an extended period of time (e.g., 12 months) The gaming behavior is not better accounted for by another mental disorder (e.g., manic episode) and is not due to the effects of a substance or medication The pattern of gaming behavior results in significant distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning Additional Clinical Features numerous unsuccessful efforts to control or significantly reduce gaming behavior, whether self-initiated or imposed by others the duration or frequency of gaming is increased over time, or the individual engage in games of increasing levels of complexity or requiring increasing skills or strategy in an effort to maintain or exceed previous levels of excitement or to avoid boredom urges or cravings for gaming dysphoria and adversarial behavior or verbal or physical aggression upon cessation or reduction of gaming substantial disruptions in diet, sleep, exercise and other health-related behaviors

At least five of the following symptoms (displayed over a 12-month span) are required for an IGD diagnosis: preoccupation with gaming (the individual thinks about previous gaming activity or anticipates playing the next game; gaming becomes the dominant activity in daily life) withdrawal symptoms (irritability, sadness, anxiety, anger) when gaming is taken away or when unable to play tolerance — the need to spend increasing amounts of time engaged in gaming unsuccessful attempts to control participation in gaming loss of interest in previous hobbies and entertainment as a result of, and with the exception of, gaming continued excess gaming despite knowledge of psychosocial problems patterns of deceiving family members, therapists, and others regarding amount of time spent gaming use of gaming to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety) the individual has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in gaming

Gaming behaviors exist on a spectrum from healthy to disordered (i.e., addictive). Video game addiction affects anywhere from 1% to 4% of people, though estimates on gaming disorder’s prevalence vary considerably.^{1 2 3} About 5% of players display problematic gaming behaviors, while another 5% exhibit at-risk gaming behaviors that could become problematic if continued.⁴

Video Game Addiction: Additional Features

• How much gaming is too much? Do a certain number of hours put someone over the top? Not according to the ICD-11, though according to the DSM-5-TR, individuals with IGD typically devote 8 to 10 hours per day to gaming and at least 30 hours a week.
• Video game addiction strains all kinds of relationships, including romantic relationships. Often, individuals with video game addiction are unable to see that their gaming is causing problems and creating tension at home and with friends.
• Financial strain can be a big part of video game addiction. In fact, studies show that in-game spending is strongly associated with gaming addiction.^{5 6}

 

Video Game Addiction: Causes, Risk Factors, Related Links

The causes of video game addiction are unclear, though, as with any form of addiction, a variety of complex factors are likely at play.

• Addictive features of gaming. From escapism and socialization to competition, video games are highly engaging, reinforcing, and stimulating by design. Prolonged, excessive exposure to immediate rewards and dopamine hits in gaming may diminish the number of dopamine receptors in the brain over time, which can lead to tolerance and further stimulation seeking.⁷ Gamers who are motivated by both escapism and achievement, and who consider gaming part of their identity, are most at risk for problematic or disordered gaming.
• Psychological and psychosocial factors like the following are all risk factors for video game addiction: impulsivity; low self-control; low self-esteem; anxiety; social skills deficits; poor school performance; poor family support; high sensation-seeking behaviors, emotional instability and low resilience; and a tendency to pursue desired goals actively.^{7 8 9}
• Existing mental/psychiatric conditions. Depression and anxiety are closely associated with video game addiction, as is ADHD.⁹

Other Factors

• Individuals with video game addiction often start playing video games at a young age.⁸
• Though video game addiction can affect anyone, males, especially adolescents and young adults, are at a higher risk for gaming disorder than other groups.^{10 11}

Video Game Addiction and ADHD

Playing video games does not cause ADHD, but researchers have found important links between ADHD and video game addiction.

• Individuals with ADHD are at greater risk for problematic gaming and video game addiction than are individuals without ADHD.^{12 13} There’s also a positive correlation between ADHD symptom severity and risk for video game addiction.¹⁴
• ADHD is associated with a more persistent course of video game addiction, decreased recovery rates, and higher rates of recurrence.¹²
• Researchers theorize that ADHD symptoms and traits like impulsivity and sensation-seeking increase susceptibility to gaming addiction.¹³

Video Game Addiction: Treatments and Support

The following treatments and interventions are available to help individuals with gaming addiction.

• Psychotherapy, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Motivational interviewing can help increase commitment to behavioral change. Group therapy is also beneficial. Individuals should seek providers and centers that focus on gaming addiction. (Based in Dallas, Texas, Escapingthe.com is a counseling service I founded that specializes in treating all kinds of screen addictions.)
• 12-step recovery programs and support groups like Internet and Technology Addicts Anonymous (ITAA) and Gaming Addicts Anonymous (GAA).
• Inpatient treatment facilities offered by centers like reSTART, based in Washington state.
• There is interest in opioid receptor antagonists (namely, low-dose Naltrexone) to treat gaming addiction, given its use in the treatment of various compulsive/behavioral addictions.^{15 16} Small studies have also found that medications like bupropion and methylphenidate decrease symptoms of gaming disorder.^{17 18} More research is needed to understand the role of pharmacological interventions in treating video game addiction.

Additional Resources

• Geek Therapeutics: From problematic gaming specialist training to mental health kits for streamers, Geek Therapeutics offers lots of relevant resources, including certifications for clinicians and mental health specialists on the use of “Geek Therapy” (i.e., the practice of integrating geek cultural interests like video games, comic books, movies, TV shows, Dungeons & Dragons, anime, and more into therapy).
• HG (Healthy Gamer) is a mental health resource platform co-founded by Dr. Alok Kanojia, a psychiatrist and recovered gaming addict who streams about balanced gaming (and more) under the handle healthygamer_GG.
• Game Quitters is an online community for people struggling with problematic gaming and video game addiction. Their hobby tool helps users find alternative activities to video games.
• Escapingthe.com courses and programs: Our Powered Up courses are designed to help parents and teens navigate balanced and healthy gaming. The Escapingthe.com experience is a day camp/summer program for teens and young adults who play video games.

Video Game Addiction: Next Steps (found at https://www.additudemag.com/)

• Take This Self-Test: Is My Child Showing Signs of Gaming Addiction?
• Read: Video Game Guidelines – 5 Smart Screen Rules for Teens with ADHD
• Q&A: “My Son Wants to Play Video Games for a Living.”

 The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Addictive Technology and Its Impact on Teen Brains” [Video Replay & Podcast #451] with Jeremy Edge, LPC, IGDC, which was broadcast on April 19, 2023.