The Dark Side of Gaming
Internet Gaming Disorder (IGD), characterized by excessive and uncontrolled gaming behaviour that significantly impairs various aspects of an individual’s life, has emerged as a growing concern for mental health professionals.
By Abhigyan/Abhinav
Online gaming has witnessed explosive growth in India, with a recent KPMG report revealing a staggering 400 million online gamers, solidifying the nation’s position as a global gaming powerhouse. This surge is primarily attributed to the widespread penetration of smartphones and the increasing affordability of internet access. A significant portion of urban households, exceeding 60 per cent, actively engage in online gaming. The Indian gaming industry is poised for substantial growth, with projections estimating 700 million gamers by 2025, driven by a diverse landscape of both casual and competitive gaming platforms.
In the United States, the Entertainment Software Association reports that video games are enjoyed in a substantial two-thirds of households. A recent study estimates that approximately 160 million American adults actively participate in internet-based gaming.
While undeniably entertaining and often characterised by intense competition, the potential for gaming addiction remains a subject of ongoing debate and scrutiny among researchers and healthcare professionals.
Reports frequently document instances of children exhibiting concerning behaviours, such as aggression, which are attributed to excessive gaming. A particularly alarming aspect is that these children often fail to recognize the problematic nature of their gaming habits. Furthermore, parental concerns may not always be readily apparent or adequately addressed.
Dr Nimesh G. Desai, formerly the Director of the Institute of Human Behaviour and Allied Sciences (IBHAS) in Delhi, observes that children are typically brought to clinical settings only when mental or physical health issues become pronounced. This suggests that the actual number of children struggling with Internet Gaming Disorder (IGD) may be significantly higher than currently reported, as many cases may go unnoticed or unreported until severe behavioural problems emerge. Dr Desai emphasises the importance of early intervention through counselling, stating that these issues can be effectively addressed if identified and addressed promptly.
A key concern regarding excessive gaming lies in its seemingly endless nature. The successful completion of one level often unlocks another, creating a continuous cycle of challenges that can captivate young minds and potentially lead to social isolation. In the context of competitive games, children may erroneously equate in-game power with real-world dominance, potentially fostering distorted perceptions of self-worth and social standing.
Dr Desai emphasises the importance of parental vigilance in identifying potential signs of problematic gaming behaviour. These may include:
A noticeable increase in aggression when denied gaming access.
Refusal to engage in other activities, such as eating or participating in social interactions.
Stubborn insistence on continued gaming despite attempts to limit access.
Dr Desai offers reassurance, stating that many children who exhibit signs of gaming addiction can successfully overcome these challenges with appropriate counselling and support.
What is Gaming Disorder?
Dr Mina Chandra, Professor and Head of the Department of Psychiatry at Dr Ram Manohar Lohia Hospital in New Delhi, defines Gaming Disorder, as outlined in the 11th Revision of the International Classification of Diseases (ICD-11), as “a pattern of gaming behaviour, both digital and video gaming, characterised 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.”
The World Health Organization recognises online game addiction as a legitimate mental health disorder, characterised by severe and persistent gaming behaviour that prioritises gaming over other essential life interests. Studies conducted in India indicate that approximately 3.5 per cent of adolescents suffer from IGD, surpassing the global average by 0.5 per cent.
Dr Chandra further notes that Indian studies reveal a higher prevalence of IGD among boys compared to girls, with an 8 per cent prevalence among boys and 3 per cent among girls.
Internet Gaming Disorder encompasses the problematic use of both online and offline video games. Current research suggests that the prevalence of IGD among adolescents ranges from 1.3 per cent to 19.9 per cent, with males generally exhibiting higher rates than females.
Dr Rushi Tamanna, Associate Professor and HOD of the Department of Clinical Psychology at the Centre of Excellence in Mental Health, ABVIMS-Dr RML Hospital in New Delhi, highlights the potential links between gaming disorders and various mental and physical health issues. Dr Tamanna states, “Gaming disorders can also be linked with anxiety, depression, obesity, sleeping disorders, and stress. People who remain physically inactive for long periods due to gaming may also be at higher risk of obesity, sleep disorders, and other health-related issues.”
Research indicates that 0.3 per cent to 1.0 per cent of the general population may meet the criteria for a potential diagnosis of Internet Gaming Disorder.
Factors such as age, gender, socioeconomic status, and access to smartphones with internet connectivity significantly influence the risk of developing IGD among adolescents.
The International Classification of Diseases (ICD) serves as a globally recognised standard for recording and reporting health conditions. It plays a crucial role in ensuring interoperability and comparability of health data across different regions and healthcare systems. The inclusion of a specific category within the ICD depends on its utility and the availability of sufficient evidence to support the existence of a particular health condition.
Dr Tamanna emphasises that for a diagnosis of gaming disorder, the behaviour pattern must:
Result in significant impairment in personal, family, social, educational, occupational, or other important areas of life.
Be evident for at least 12 months.
IGD is characterised by persistent and recurrent involvement with video games, often leading to:
Significant impairment in daily work and/or educational activities.
Loss of interest in other social activities.
Deterioration of relationships.
Diminished educational or career opportunities.
Gaming as a means of escaping anxiety, guilt, or other negative emotional states.
Research has established a strong link between excessive digital gaming and adverse mental health outcomes, including loneliness, depression, and even suicidal thoughts. This concern was amplified during the COVID-19 pandemic, when lockdowns led to a significant increase in gaming app downloads across India.
Symptoms of IGD include:
Preoccupation with gaming.
Withdrawal symptoms (sadness, anxiety, irritability) when gaming is interrupted or unavailable.
The need to increase gaming time to maintain satisfaction.
Difficulty reducing or quitting gaming.
Defining and Diagnosing Gaming Disorder
The DSM-5, the diagnostic manual used by mental health professionals, outlines specific criteria for diagnosing Gaming Disorder. It emphasises that the gaming behaviour must cause significant impairment or distress in several aspects of a person’s life. This proposed condition is limited to gaming itself and does not encompass problems with general internet use, online gambling, or the use of social media or smartphones.
Under the proposed criteria, a diagnosis of IGD would require experiencing five or more of these symptoms within a year. The condition can include gaming on the internet, or on any electronic device, although most people who develop clinically significant gaming problems primarily play on the internet.
Whether internet gaming should be classified as an addiction/mental disorder is the subject of much debate and a growing body of research. There is neurological research showing similarities in changes in the brain between video gaming and addictive substances.
According to a report, the validity and reliability of the criteria for internet gaming disorder were examined by comparing them to research on gambling addiction and problem gaming, and estimating their impact on physical, social, and mental health. The study found that among those who played games, most did not report any symptoms of IGD, and the percentage of people that might qualify for internet gaming disorder is extremely small.
The two clinical vignettes illustrate distinct developmental pathways: an internalised pathway characterised by the development of social anxiety, emotional and behavioural avoidance, and an externalised pathway characterised by low levels of emotional regulation strategies and impulsivity. In both clinical cases, attachment issues played a key role in understanding the specific associations of risk and maintaining factors for IGD. Moreover, gaming behaviours may be seen as specific forms of maladaptive self-regulatory strategies for these two youths. These clinical observations support the assumption that gaming use in adolescents should be viewed within a developmental framework, including key aspects of emotional development that represent significant targets for therapeutic interventions.
Adolescence represents a period of vulnerability for the emergence of addictive behaviours, with a peak incidence during the transition into young adulthood. Developmentally, teens are focused on establishing autonomy and identity through a series of social experiences within peer groups. The need to integrate multiple, and sometimes conflicting, demands and developmental needs may result in interpersonal conflicts and emotional distress. In this context, addictive behaviours can emerge as a means of developing a new sense of identity within a peer group and as a way to relieve emotional distress. While the starting point of addictive behaviour is often during adolescence, etiological factors are rooted in childhood, especially early-environmental factors and cognitive and socio-emotional dysfunctions.
Dr Rushi Tamanna emphasises that most of the literature devoted to severe gaming misuse in adolescents comes from studies conducted in general populations, internet-recruited samples, or outpatient clinics. Only anecdotal reports exist concerning youths with severe psychiatric disorders. However, in this latter group, the aggregation of academic problems, social withdrawal, and the severity of internalised symptoms puts them at very high risk of developing gaming misuse. Moreover, if Internet gaming misuse alters the course of psychiatric symptoms in youths with severe psychiatric disorders, recognizing and treating dual diagnoses would represent a clinically relevant approach.
According to the All-India Gaming Federation, India’s online gaming industry is expected to be worth 15,500 crore by 2023. A 2019 survey by the US-based Limelight Networks found that India had the second largest number of gamers after South Korea, and while time spent online is still not as high as in other countries, it found that almost a quarter of adult Indian gamers had missed work while playing games.
The World Health Organization categorised gaming disorder as a mental health condition in 2018. However, as the pandemic increased screen time across age groups, concerns have been growing. Last month, China limited gamers under 18 years to just three hours of online games per week, during specified times, and made the industry responsible for enforcing the restriction.
In India, legal focus has been on recent laws in the southern States seeking to ban online games such as rummy, poker, or even fantasy sports which offer prize money or financial stakes. The Kerala High Court quashed such a law in the State, accepting the industry’s stance that, as games of skill rather than chance, they should not trigger bans on gambling. However, worried parents, psychiatrists, and mental health advocates warn that the dangers go well beyond monetary motivations.
For gaming disorder to be diagnosed, the behaviour pattern must be severe enough to significantly affect a person’s functioning in personal, family, social, educational, occupational, or other significant domains, and it must have been present for at least a period of 12 months.
According to numerous research studies, mental health conditions like depression, anxiety, and stress as well as gaming disorder may co-occur. Users who struggle with these underlying problems may develop the habit of playing video games excessively because it allows them to escape from the uncomfortable emotions they experience; in some cases, this may be the only thing that helps them feel better. The emotional, physical, social, and mental health of those who meet the criteria for gaming disorder is frequently worse.
The act of playing video games is more addictive than the actual games (and its effect on our brains). This is due to the fact that playing video games is very stimulating and results in the release of large amounts of dopamine.
Video games generate challenges that are easy to accomplish and consistent, which divert us from achieving meaningful goals outside of gaming. Also, people typically tend to feel happy after finishing tasks.
As people experience immediate gratification for achieving these in-game successes, gaming can be addicting. This incentive mechanism eventually results in reinforced behaviour (e.g., more gaming).
Gaming disorder has negative effects on finances, employment, and education. The expense of the equipment and the required high-speed internet might add significantly to the financial difficulties. Additionally, the time spent concentrating on playing the games can eat up time that could be spent on academics or a profession.
Drug abuse is another significant concern for those with gaming disorders. Since depression and gaming disorder are strongly correlated, many addicts may find themselves receiving antidepressant prescriptions and using them. Because these medicines are difficult to quit using due to the withdrawal symptoms that arise, such as nausea, anxiety, irritability, and, in extreme circumstances, greater depression, an addiction to them may develop. Additional substance misuse problems could arise as a result of the addict’s lack of concern for their health.