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.