Internet gaming disorder

The concept of Internet gaming disorder (IGD) is controversial. After all, how can playing video games be a serious mental health problem? However, as with other behavioral addictions, what begins as normal behavior can become maladaptive and harmful.

Approximately three percent of the world’s population suffers from an addiction to gaming. Something as seemingly innocent as playing video games can consume your life. Let’s look at the difficulties related to internet gaming disorder and how therapists can best address them.

Summary

• Internet Gaming Disorder (IGD) is a behavioral addiction that can significantly impact school, work, relationships, and daily functioning when gaming becomes compulsive.
• Risk factors for IGD include younger age, family history of addiction, dysfunctional family dynamics, ADHD, anxiety, and using gaming as a form of escapism.
• Cognitive Behavioral Therapy (CBT), mindfulness-based approaches, motivational therapy, and group therapy have all shown promise in reducing problematic gaming behaviors.
• Therapists play a key role in teaching coping skills, involving families, addressing co-occurring mental health conditions, and helping clients develop healthier routines and relapse prevention strategies. Clinicians can use EHRs to streamline to securely communicate with caregivers and interdisciplinary teams.

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What is Internet Gaming Disorder?

Internet gaming disorder is a bit of a misnomer. It doesn’t have to involve the internet. It is a behavioral addiction to digital gaming that can be online or offline. This is reflected in the International Classification of Diseases, 11th revision (ICD-11), which simply calls the condition “gaming disorder” (6C51).

Signs and symptoms of Internet Gaming Disorder

A persistent pattern of gaming behavior manifested by the following:

• Impaired control over gaming behavior. For example, people with gaming disorder will not be able to control the frequency, duration, and termination of their play.
• Gaming behavior takes precedence over other responsibilities and daily activities. Gaming is prioritized over work, school, and relationships.
• Continuation or escalation of gaming behavior despite negative consequences, including family conflict, poor work and school performance, isolation, and other negative impacts on health (e.g., forgetting to sleep or eat).
• The key differentiating factor between gaming disorder and regular gaming is that the behavior must significantly impair functioning in social life, work, school, or family relationships.
• Other common symptoms related to gaming disorder are hiding game use, psychological withdrawal, loss of interest in different activities, and becoming angry when asked to stop.

Note: While internet gaming disorder is not yet recognized as an official disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), it has been designated as a “condition in need of further research.”

This means that IGD, due to the mounting evidence, will almost surely be recognized as an official diagnosis in the next edition of the DSM.

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Risk factors for Internet Gaming Disorder

The occurrence of IGD is linked with the following biological and environmental elements:

Age: IGD appears to be largely a disorder of youth. Adults do play video games, but adolescents and young adults have almost twice as fast a progression to problematic gaming as adults.

Family dynamics: Dysfunctional family relationships—including lack of parental monitoring—are linked to the occurrence of gaming disorder.

Gender: The gender of those with IGD is overwhelmingly male, with approximately 63 percent of people diagnosed with IDG being recognized as men or boys.

Family history: Biology appears to play a large role in the development of gaming disorder. Family history of addiction is highly associated with its occurrence.

Psychiatric conditions: Gaming disorder possesses high comorbidity with generalized anxiety disorder (GAD) and attention-deficit hyperactivity disorder (ADHD).

Reason for playing: People who play video games for escapism as opposed to recreation are more likely to develop IGD.

Diagnosis and assessment of Internet Gaming Disorder

Besides clinical expertise, several measures have been developed to help assess addictive gaming behavior.

Here are a few of the most relevant:

• The Gaming Addiction Scale-7 is one of the most popular and well-studied assessment measures of internet gaming. The main critique of the instrument is that its psychometric properties are not as robust as those of some others, and it doesn’t cover all diagnostic criteria.
• The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF) is another popular screening instrument. It covers all diagnostic criteria but has shown inconsistent reliability across different cultures.
• The Ten-Item Internet Gaming Disorder Test (IGDT-10) exhibits strong psychometric properties across cultures while encompassing the ICD-11 criteria for the disorder.

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Internet Gaming Disorder treatment approaches

Although treatment for IGD is in its infancy, these interventions have shown promise:

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy is the most utilized type of treatment for gaming disorder. It is highly effective in improving symptoms of IGD, especially in the short term.

Acceptance and Cognitive Restructuring Intervention Program (ACRIP)

This intervention mixes CBT concepts with mindfulness meditation. It has reduced IGD symptoms and improved general well-being.

Motivational Enhancement Therapy

Motivational enhancement therapy is another treatment that is often utilized alongside CBT to increase individuals’ motivation to stop addictive behaviors. The combined approach has been used successfully to decrease time spent playing video games and increase learning performance.

Group therapy

Group therapy is a popular treatment option for addiction, offering support and motivation, along with clinical interventions. One group therapy treatment that has been used effectively with gaming disorder is craving behavioral intervention or CBI. CBI is a cognitive-behavioral offshoot that utilizes specific coping methods to reduce cravings for internet gaming.

Medication

Antidepressant and ADHD medications are primarily used to treat IGD. Bupropion (Wellbutrin) has shown the most effectiveness overall. It has alleviated cravings for gaming, decreased time spent on the internet, and improved symptoms of depression. Methylphenidate (Ritalin) has also been found to be successful in decreasing the time spent gaming and reducing the severity of symptoms.

Behavior limits

People who experience constraints on their gaming time tend to have more positive outcomes. Children of parents who set limits on gaming time and content experienced better sleep, gained less weight, obtained better grades, and displayed more prosocial behavior.

Role of therapists in Internet Gaming Disorder

Therapists hold a primary role as collaborators and experts in the treatment of IGD, with families also playing a valuable role, especially for younger clients. Therapists frequently focus on the following areas to guide treatment:

Teaching coping skills

• Relaxation and mindfulness techniques (breathing, mindfulness)
• Problem-solving skills
• Learning ways to tolerate boredom or discomfort

Behavioral interventions

• Creating structured daily routines
• Gradual reduction of gaming time
• Introducing healthy replacement activities (e.g., exercise and social interactions)

Family involvement (especially for children and adolescents)

• Setting consistent boundaries at home
• Improving communication
• Deescalating conflict

Treating comorbid conditions

• If disorders like GAD, ADHD, or depression are present, therapists will address those alongside gaming behavior.
• Other conditions may need to be managed first if they are determined to be the underlying source of excessive gaming behavior.

Relapse prevention

• Identifying risks factors
• Setting realistic expectations
• Developing relapse prevention plans

How EHRs can help with documentation

Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.

They allow therapists to:

• Use and customize templates (e.g., SOAP, DAP, and others) or build their own to streamline note writing and ensure consistency.
• Link notes to treatment plans, goals, and session history so client progress is easily tracked over time.
• Utilize e-fax and secure document sharing via client portal to safely exchange information with clients or other providers while maintaining confidentiality.
• Leverage dictation and telehealth transcription, which can automatically convert sessions into therapy or assessment notes, saving time and reducing manual entry.
• Take advantage of AI features that streamline documentation by automatically populating intake form data into assessment templates and generating complete therapy and assessment notes from the information you provide, all with a single click.

Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:

• Automatically transcribing session audio (if permitted) and highlighting key moments (e.g. emotional shifts, major themes).
• Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
• Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.

Together, structured SOAP‑type notes, good EHR platforms, and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.

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• Flexible notes
• Template library
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• Insurance claims
• Client portal
• Telehealth
• E-fax

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References

Addiction https://Help.com. Video game addiction statistics. https://www.addictionhelp.com/video-game-addiction/statistics/

Ali, A. M., Al-Amer, R., Atout, M., Ali, T. S., Mansour, A. M. H., Khatatbeh, H., Alkhamees, A. A., & Hendawy, A. O. (2022). The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA. Healthcare, 10(3), 490. https://doi.org/10.3390/healthcare10030490

Deng, L. Y., Liu, L., Xia, C. C., Lan, J., Zhang, J. T., & Fang, X. Y. (2017). Craving behavior intervention in ameliorating college students' internet game disorder: A longitudinal study. Frontiers in Psychology, 8, 526. https://doi.org/10.3389/fpsyg.2017.00526

Gentile, D. A., Reimer, R. A., Nathanson, A. I., Walsh, D. A., & Eisenmann, J. C. (2014). Protective effects of parental monitoring of children's media use: a prospective study. JAMA pediatrics, 168(5), 479–484. https://doi.org/10.1001/jamapediatrics.2014.146

Lin, C. Y., Imani, V., Broström, A., Årestedt, K., Pakpour, A. H., & Griffiths, M. D. (2019). Evaluating the Psychometric Properties of the 7-Item Persian Game Addiction Scale for Iranian Adolescents. Frontiers in Psychology, 10, 149. https://doi.org/10.3389/fpsyg.2019.00149

Hofstedt A and Söderpalm Gordh A (2024) Young and adult patients with gaming disorder: Psychiatric co-morbidities and progression of problematic gaming. Frontiers of Psychiatry 15:1423785. https://doi.org/10.3389/fpsyt.2024.1423785

International Classification of Diseases, 11th Revision. (2026). 6C51 Gaming disorder. https://icd.who.int/dev11/l-m/en#!/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F1448597234

King, D. L., Chamberlain, S. R., Carragher, N., Billieux, J., Stein, D., Mueller, K., Potenza, M. N., Rumpf, H. J., Saunders, J., Starcevic, V., Demetrovics, Z., Brand, M., Lee, H. K., Spada, M., Lindenberg, K., Wu, A. M. S., Lemenager, T., Pallesen, S., Achab, S., Kyrios, M., … Delfabbro, P. H. (2020). Screening and assessment tools for gaming disorder: A comprehensive systematic review. Clinical Psychology Review, 77, 101831. https://doi.org/10.1016/j.cpr.2020.101831

Király, O., Bőthe, B., Ramos-Diaz, J., Rahimi-Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze, J., Nuyens, F., Karila, L., Griffiths, M. D., Nagygyörgy, K., Urbán, R., Potenza, M. N., King, D. L., Rumpf, H. J., Carragher, N., & Demetrovics, Z. (2019). Ten-Item Internet Gaming Disorder Test (IGDT-10): Measurement invariance and cross-cultural validation across seven language-based samples. Psychology of addictive behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 33(1), 91–103. https://doi.org/10.1037/adb0000433

Kochuchakkalackal Kuriala, G., Reyes, M.E.S. (2020) Efficacy of the acceptance and cognitive restructuring intervention program (ACRIP) on the internet gaming disorder symptoms of selected asian adolescents. Journal of Technological and Behavioral Sciences, 5, 238–244. https://doi.org/10.1007/s41347-020-00132-z

Stevens, M. W., Dorstyn, D., Delfabbro, P. H., & King, D. L. (2021). Global prevalence of gaming disorder: A systematic review and meta-analysis. The Australian and New Zealand Journal of Psychiatry, 55(6), 553–568. https://doi.org/10.1177/0004867420962851

Stevens, M. W. R., King, D. L., Dorstyn, D., & Delfabbro, P. H. (2019). Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis. Clinical psychology & psychotherapy, 26(2), 191–203. https://doi.org/10.1002/cpp.2341