Here's what you need to know about gaming disorder, its warning signs, and what to do if you believe your child is suffering from it.

Boy Playing Xbox Video Game
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Just like scrolling through social media and watching video after video on YouTube, playing video games can be habit-forming. In September 2018, the World Health Organization (WHO) went so far as to classify gaming disorder as a mental health disorder in the 11th Revision of the International Classification of Diseases (ICD-11). Previously, the American Psychiatric Association (APA) outlined the potential problem as "internet gaming disorder." Now, an incident illustrating this very concern is making headlines: This month, an 8-year-old from Memphis, Tennessee was sent to the emergency room after reportedly refusing to put down his video game controller for a bathroom break, which resulted in severe constipation.

Here, what you need to know about gaming disorder, its warning signs, and what to do if you believe your child is suffering from it.

What are the warning signs of gaming disorder?

WHO defines gaming disorder as "a pattern of gaming behavior characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences."

Petros Levounis, MD, professor and chair of the Department of Psychiatry at Rutgers New Jersey Medical School in New Brunswick, New Jersey says this behavior manifests as red flags that are reminiscent of those that occur with substance use disorders, including "a change in behavior of a kid, being more isolated than they were before, spending tremendous hours on the phone or internet with gaming, the grades starting to fall, fewer friends than they used to have."

The APA points to additional signs:

  • Preoccupation with gaming
  • Withdrawal symptoms when gaming is taken away or not possible (sadness, anxiety, irritability)
  • Tolerance, the need to spend more time gaming to satisfy the urge
  • Inability to reduce playing, unsuccessful attempts to quit gaming
  • Giving up other activities, loss of interest in previously enjoyed activities due to gaming
  • Continuing to game despite problems
  • Deceiving family members or others about the amount of time spent on gaming
  • The use of gaming to relieve negative moods, such as guilt or hopelessness
  • Risk, having jeopardized or lost a job or relationship due to gaming

What makes gaming so addictive?

According to the Cleveland Clinic, unlike drinking or drug use, the high that comes with playing video games is unpredictable. Players never know exactly when or if they'll receive reinforcement. This is exactly what keeps them engaged. Many video games—especially massively multiplayer online role-playing games (MMORPGs)—"are designed to make players repeat behaviors in the quest of that gaming high," the Clinic notes.

How is gaming disorder diagnosed?

Before a child can be diagnosed, they have to exhibit negative behavior that has caused "significant impairment in personal, family, social, educational, occupational or other important areas of functioning" for 12+ months, according to WHO. Basically, it can't be considered a diagnosis until the behavior has fully dominated the player's life.

Dr. Levounis appreciates this timeframe, as it serves to put the brakes on overdiagnosis. "There are a lot of good things about the internet, and we should not be quick to assign the blame on internet and internet gaming," he says. That said, he encourages parents who see significant problems before that one-year mark to seek treatment for their child.

Who is at risk?

A study published in American Journal of Psychiatry in March 2017 found that 0.3 to 1.0 percent of the general population might qualify for a potential diagnosis of internet gaming disorder. Adolescents and young adults who have mental health conditions like depression or anxiety may be more likely to suffer from gaming addiction, according to the Cleveland Clinic.

It also bears noting that gaming disorder can be the cause or effect of another diagnosis (such as depression, anxiety, bipolar disorder, personality disorder, eating disorder, etc.). "Gaming addiction can act as self-medication against the problem a kid has," Dr. Levounis says. "Say they are depressed and they find solace in the imaginary world of Fortnite. A second possibility is that other conditions are the consequence of the gaming addiction. Insomnia is a classic one. A kid can spend so many hours with gaming that she or he ends up not sleeping well and that has consequences: anxiety, irritability, restlessness." A third possibility: A child is battling gaming disorder and a separate mental health diagnosis simultaneously.

What can parents do if they suspect their child has gaming disorder?

Setting limits on your child's game playing time is a first step, as is engaging with other parents who might be grappling with the same issue. In general, Dr. Levounis recommends "being in touch with the kid's immediate environment and overall culture."

He also advises parents ask their child, "Have you ever played more than you intended to?" Then, take the conversation in a more general direction. "Have an inquiry about other aspects of a kid's life, other things a kid may not see as going quite as well as he or she would like—anything from dating to their social life or weight control," Dr. Levounis says. This can pave the way for a discussion about seeing a professional.

"One of the worst things we've seen is misdiagnosis of significant psychiatric disorders and kids receiving the wrong treatment," Dr. Levounis points out. For that reason, working with an experienced, qualified mental health care professional is key. For more information or to find a provider near you, check out the American Academy of Addiction Psychiatry site.