Addicted to Video Games?

Internet Gaming Disorder or “Video Game Addiction”

One of my specialty research area are video games, combining my passion for new technology (like video games) with psychology. In my blog today, I want to discuss “Video Game Addiction” (or Internet Gaming Disorder, the more scientific name for it), to shed some light on this issue from a professional psychological perspective.

If you recognize yourself in some of the symptoms mentioned, or if you think a loved one may suffer from video game addiction, please do not hesitate to connect with me or another psychologist or mental health professional who is familiar with this topic.

As a researcher and psychologist, I am very familiar with “internet addiction”, video game addiction or Internet gaming disorder for over a decade now. Several studies confirmed that a high amount of time spent with playing online games is associated with higher levels of depression, loneliness, anxiety disorders or aggression. On the other hand, gamers seem to have more fun with playing video games, and most of them report a greater number of friends they found online. Therefore, the occasional gaming can definitely increase the quality of life!

From a professional point of view, I do not believe that everyone who plays video games is “addicted”. I do not even believe that everyone who plays video games “a lot” is automatically addicted. My own research suggests that we have to distinguish between a healthy and an unhealthy use of video games. In my practice, my goal is usually a “controlled use” of video games; it can be part of a healthy lifestyle when used in moderation.

However, where do we draw the line between a “healthy” and “addicted” use of video games?

Internet Gaming Disorder: Criteria

Millions of people play video games online without no serious negative effects at all. They have fun engaging with other players, they collect items online, they go on quests, and they are able to explore virtual worlds. That’s fun!

However, a small minority of gamers seem to have problems with an “overuse” of video games. These problems seem to be comparable to behavioral addiction, which is why the American Psychiatric Association (APA) introduced “Internet Gaming Disorder” (IGD) in their recent edition of the Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5) as “a condition that needs further research”.

The DSM-5 proposes nine criteria for IGD:

  • preoccupation,
  • withdrawal,
  • tolerance,
  • unsuccessful attempts to control the use of video games
  • loss of interests in other activities,
  • continued excessive use despite psychosocial problems (e.g., problems at work)
  • deceiving (lying about the use of video games)
  • escape, and
  • functional impairment.

An excessive use of the Internet in general (for either video games, social media, pornography, etc.) seems to be linked to a variety of comorbid (co-existing) psychopathological and personality differences. Studies suggest that users with depression tend to spend significantly more time online compared to non-depressed users (mood disorders seem to be connected with a higher use of the Internet). It is interesting to note that massively multiplayer online roleplaying game (MMORPG) users usually also have higher depression scores compared to other game types. It also seems like anxiety is another significant predictor of an excessive or problematic Internet use.

However, it is very important to note that correlation does not equal causation! Just because MMORPG user seem to have higher levels of depression does not mean that MMORPGs lead to depression. It may actually be quite the opposite – playing games like MMORPG can be very similar to “self-medication” – users with depression usually also have a lack of external gratification, something that video games can very easily provide, gratification online (e.g., by exploring worlds, finishing quests, collecting rare items, etc.). While this is not necessarily a bad thing, further studies are needed to look into long-term effects of the use of online-games for purposes like gratification or stress management.

Differences between engagement and addiction

My own research points out that there are two factors explaining an an “over-use” of video games:

A) Engagement is connected to variables like cognitive salience, tolerance, and euphoria. It means that engaged players have fun playing the games, they report feelings of euphoria, and they need to play more to experience the same feeling of euphoria they had in the beginning of playing games.

B) Addiction is connected to symptoms like conflicts, withdrawal symptoms, relapse and reinstatements, and certain behavioral symptoms. However, just because someone spends a lot of time playing video games online, he/she/they cannot be labeled as addicted right away.

Early warning signs of “addiction”

It is very important to note that even in a large sample of high-level players, I was only able to classify 3% of them as “addicted”. 97% of high-level players are NOT addicted; therefore, I caution against labeling any gamers as “addicted” just because they play a lot of games online or because they spend a lot of time per week online playing games.

Compared to engaged players, my research suggests that addicted players seem to spend more time playing games online: 32 hours/week compared to 21 hours/week, on average. While 21 hours per week is still a lot of time spent online, it is not necessarily automatically addiction.

While engagement might be just experiencing fun playing games, addiction is a more serious issue. Some of the warning signs of behavioral addiction to video games include:

  • Playing more and more, investing more and more time and money into video games
  • Escapism: using video games as a vehicle to avoid real life issues
  • Skipping meals, showers or important meetings because of video games
  • Deceive other people, lying to other people about the amount of time spent with video games
  • Problems at work or in school, the performance decreases

Assessment and treatment possibilities

If you think that you or a loved one might suffer from IGD or “video game addiction”, I recommend that you talk to me or any other psychologist with experience on that topic.

I usually use several surveys to get a complete picture of IGD and surrounding factors like mood disorders, anxiety disorders, and negative effects on one’s life. I may also have a look into who else is affected by an over-use of games; for example, in many cases a spouse reaches out to me because a partner’s gaming time leads to marital problems.

For treatment, certain cognitive-behavioral techniques seem to be the gold-standard for the treatment of IGD. I usually recommend to address one or more of the following steps:

  • Explore and examine any thoughts that lead (or are connected) to IGD
  • Explore behavioral triggers that lead to a use of video games
  • Replace irrational thoughts with “healthier” ones
  • Modify behavioral triggers
  • Modify any thoughts, feelings and ultimately the behavior that can lead to IGD

Each individual with problems coming from an “overuse” of games is unique, therefore it is important to adjust any therapy individually as well.


While millions of people play video games online without any serious negative effects at all, a small minority seem to have problems with an overuse of video games. Some of the warning signs include spending more and more time (and sometimes money) for video games, negative consequences on one’s life (such as work, school, or relationship issues), using video games to escape “real life” issues, and skipping meals, showers or important meetings because of video games. Cognitive-behavioral tools are useful to address some of these issues; therapy usually includes exploring and modifying behavioral triggers, thoughts and emotions. One of my therapy goals usually includes a “controlled use” of video games; it can be part of a healthy lifestyle when used in moderation.

Please note: Parts of this blog come from my peer-reviewed publication: Lehenbauer-Baum, M. et al., (2015). Addiction and Engagement: An Explorative Study Toward Classification Criteria for Internet Gaming Disorder. Cyberpsychology, Behavior, and Social Networking, 18(6), 343–349.

Dr. Mario Lehenbauer-Baum is a Licensed Psychologist in private practice in Wilton Manors, Florida. This blog post is strictly for informational purposes and is not intended to be a substitute for professional counseling or therapy.

In the spotlight: How a cognitive bias impacts your perception of reality

Many of my clients are surprised when I explain that our perception of what’s happening around us is usually not necessarily “real”. Among many things, cognitive biases also influence the way how we perceive certain things in life, and it affects our emotions and behaviors as well. Today’s blog post is intended to provide some information about cognitive biases.

Rational thinking is very slow, if you think about it (pun intended). To rationally make a decision, we usually have to slow down our thinking; we have to consciously think and deduce information in front of us, how we can get from “A” to “B” to “C” etc. – it’s slow!

While this slow way of thinking can be more efficient, it’s also incredibly time-consuming. Thousands of years ago, in order to survive in wilderness, we simply didn’t have this time – we had to “connect the dots” fast to compare the information (or whatever is happening in front of us) with and connect to other information that’s already stored in our brain. Our brain is literally hardwired to make certain cognitive errors, to use mental shortcuts to speed up mental processing, without us rationally realizing it.  Sometimes it works out, but sometimes it’s also not useful for us because it’s subject to certain limitations.

We all construct our own “subjective reality” based on our hardwired cognitive connections and the information that’s already stored in our brain. To construct our own reality quickly, we also need to process information quickly, so we rely on cognitive biases as mental shortcuts. However, a cognitive bias can also be a disadvantage – it can be a systematic error in thinking, processing and interpreting information in the world around us.

Therefore, whenever clients work with me, I usually also explain how our brain processes information. It’s helpful to know how certain cognitive biases influence how we interpret and perceive information from other people; at the end of the day, it’s also influencing our emotions and subsequent behaviors. It’s important to be able to “re-think” some of our initial decisions by slowing down and appropriately rationalizing certain decisions. There are quite a few cognitive fallacies out there, but I’d like to introduce you to some of the cognitive biases that I often work with.

Spotlight effect

This cognitive bias makes people believe that they are being noticed much more than they really are. Think about it – you live with yourself 24/7, you always hear your own thoughts, always thinking about yourself. It sometimes makes us believe that other people are similarly thinking about us. It is important to remember that most people are more concerned about themselves than they are about you. The next time you feel like the center of attention, it’s important to remember the spotlight effect. Also, try to remember that most other people are most likely concerned with their own thoughts.  


Human minds connect things to speed up cognitive processes; your judgement can be heavily influenced by the first piece of information. Whenever we make estimates and judge if something is cheaper, better, taller, etc., we usually judge it from the reference point of our first available information, the “anchor”. This knowledge is especially useful for financial negotiations because the first number we see has a significant effect on how we perceive the following prices. For example, if you see pants for $ 1500 and then another pair of pants for $ 100, you perceive the second pair automatically as “cheap”. If you see a pair of pants for $ 20 and then another one for $ 100, you would perceive the second pair as “expensive”. 

Confirmation Bias

A confirmation bias impacts how we gather, store, and disregard information. Human minds are prone to look out for any pieces of information that justifies our existing beliefs. Any other pieces and bits of information that possibly contradict our existing beliefs are more easily disregarded as “fake”, not relevant, or we simply oppose it. Over time, our own assumptions take over and confirm themselves. This is especially relevant for people with social fears; they constantly monitor their environment for any negative social clues. Even neutral behavior may be interpreted as something negative, while positive behavior is disregarded as a “fluke” or just random accidental behavior. It’s also relevant for political beliefs that may be reinforced by only consuming certain news or websites.

Sunk cost fallacy

It may be harder to let go (loss aversion) of something or someone if a lot of time, energy, emotions or money was already invested. However, we also lose more in the process of hanging on. Human minds have a natural aversion to pain, and it creates pain and uncomfortable feelings when we realize that something or someone is a lost cause. Our brain is hardwired to avoid any uncomfortable feelings or pain, so we try to hang on. We may justify it by thinking that it has to get better at some point; sunk cost fallacy makes it difficult for people to let go. It can cause us to make unwise investments, or to hang on to unwise investments or unhealthy relationships (because we tell ourselves that we already invested so much money and/or time).

Dunning-Kruger effect

This cognitive bias describes the behavior of people who wrongly overestimate their knowledge or ability in specific areas. Experts usually know how much they know, but they also know how much they don’t know, and they are prone to underestimate their abilities and skills. However, it is very easy to be over-confident if you only have a simple idea of something; your incompetence keeps you from recognizing your own inability.

Framing effect

The way we perceive our information is strongly influenced by how it is delivered and framed. The advertising industry utilizes the framing effect by displaying information in a certain way. For example, it makes a difference if something is labeled as “5% fat” or “95% fat free” although the information behind it is the same. It also depends on how things are said and how the visual information surrounding it is presented (by using certain keywords, colors, fonts, etc.).

Availability heuristic

This cognitive bias is another example of a mental shortcut. Whatever information is easiest for us to recall or retrieve from our memory, that provides the best frame of reference for our future decisions. For example, if people see something in news stories, they are more likely to exaggerate the likelihood of things to happen. If you hear more stories about people being laid off, you may reconsider your spending habits; even though it may not affect you directly, you may overestimate the likelihood of you being laid off. 

Optimism bias

The optimism bias lets people believe that they are less likely to experience a negative event; the likelihood of positive outcomes is overestimated. A good example for that is smoking. Most people know and are aware of how negatively smoking affects their health. However, most people also try to rationalize it by saying “I can stop any time” or “It won’t affect me”, thus overestimating positive outcomes. One way to combat your optimism bias is to use your loss aversion (think about the losses and expenses that are likely to occur because of bad habits), and utilize your availability heuristic (make a conscious effort to read up on negative consequences, thus make bad events or consequences more easily retrievable from memory).

Dr. Mario Lehenbauer-Baum is a Licensed Psychologist in private practice in Wilton Manors, Florida. This blog post is strictly for informational purposes and is not intended to be a substitute for professional counseling or therapy.