Up Close With Dr. E

Understanding the emerging Internet Gaming Disorder


Keep your nose to the grindstone, your shoulder to the wheel and your eyes on the ball. Above all, don’t blink, for if you do, the world could vanish. Everyday, the world as we know it is being re-sculpted by the hands of technology.

Each of the following changes has an electronic signature:

Work — the workplace is now a homeplace.

School — Chalk and blackboard eclipsed by I-pads, laptops, and remote learning.

Healthcare — Bedside manner becomes telemedicine.

Recreation — Fishing poles and campfires give way to internet gaming with dazzling virtual worlds powered by Xbox, Nintendo and PlayStation.

Keeping pace with these changes is hard. But what if you are raising children? How can parents preserve and protect the innocence of childhood in the face of electronic dangers?

Today’s article is about an emerging disorder called Internet Gaming Disorder, or IGD. By learning about IGD, you are in a better position to protect your children, and yourself, from this new species of non-drug, or behavioral addiction.

Today’s column begins with Joshua, a boy who progresses from playing computer games, to competitive team internet gaming. As you read about Joshua, see if you can detect these elements of addiction:

Preoccupation with gaming drives daily use.

As use increases, tolerance occurs, which pushes use to 5-10 hours per day.

Past hobbies and non-gaming friends are dropped.

Despite harm — falling grades, loss of sleep, parental arguments — gaming continues.

Deception and lies about excessive gaming set in.

If a parent removes all gaming, withdrawal symptoms — anger, irritability, and anxiety, occur.

Gaming becomes an escape from life’s problems, as well as a powerful social network.

Portrait of a Gamer:

Meet Joshua, 5 feet 10 inches, 140 pounds, thin as a rail, curly brown hair and photogenic smile. That’s him at 17. Let us go back to when he was 6.

Born in St Louis, whose father, Michael, is a computer engineer His mother, Denise, is a second grade teacher. He has two older sisters. Henpecked by sisters, Josh would retreat to his room to practice his passion — the trumpet. On his walls hung posters of iconic trumpet players: Louis Armstrong, Charlie Parker, Miles Davis. Under his mother’s musical wing (she played piano) he started private lessons.

At 10, he became first chair in the school band. At 12, he was hired to play in a pit orchestra for musicals such as “Cats” and “Hamilton.” But then at 13, his world split apart when his parents divorced. He moved with his mother to Indiana, where she took a teaching job. His sisters were in college, so Josh found himself alone. He started school, played in the marching band, but did not make friends.

The sole contact with his father was online, where they played car racing games and Minecraft. On his 16th birthday, his father bought him two, expensive gaming systems. Josh entered the world of competitive team internet gaming.

By 17, Josh had two passions: his girlfriend Natalie, and internet gaming. Natalie liked gaming, so on weekends they would play 6-10 hours at a time. He coined a gamer name, “Phantom Four,” which he earned by his gaming skill of sneaking into enemy territory without detection.

The relationship with his mother shifted radically. Daily arguments ignited easily ­— “Josh, get up for school, you’re late,” “Josh, school called, you are failing algebra,” and “why did you lie to me about quitting band?”

Josh dumped his girlfriend and stopped all contact with his dad. Desperate to help her son, Denise removed his gaming systems. Josh went wild — “I need them back now! I promise to only play on weekends.” For the next three days, Josh was agitated, hostile and depressed.

After Denise made him sign a contract that he would limit his gaming to 10 hours per week, she returned his games. Two week’s later, at 2 a.m. on a Sunday morning, she eavesdropped at his door.

“Game time guys! It’s Phantom Four and I’ve got cheat codes for extra ammo — Time for Call of Duty!”

“Slayer-six online (Steve from LA).”

“Dead Mel ready (Mel from Sydney Australia).”

“I’m good,” replied Brit-kill (Shawn from London).”

As Denise listened, she was aghast at the kinship the four boys had forged. “My god,” she thought, “it’s as if they are a family.” She sighed, “have I lost my son?”

Questions and Answers:

Q1: Is IGD a formal disorder in the USA?  Not yet. It is listed in the DSM 5 (the psychiatric diagnostic manual) as an emerging condition under study. In China, IGD is a bona fide diagnosis with a specific treatment.

Q2: Is IGD common? One Asian study found IGD occurs in 8.4% of males, and 4.5% of females, for the age range of 15-19.

Q3: Dr. E, you have portrayed IGD as an electronic moonshine, like alcohol or cocaine. How could a non-drug addiction wield such power? Neuroscience, the study of how the brain works, has discovered a common mechanism for all addictions, be it drugs, sex, food, gambling or IGD. The ability of IGD to highjack Joshua’s life is due to two specific features of internet gaming: the thrill of gaming ignites the brain’s pleasure/reward center, and it creates bonds of loyalty among team players.

Q4: As a parent, how do I protect my children from gaming problems?  Set firm time limits for gaming. Do not allow binges — 10 hours of continuous play — allocate two hours per day of gaming, with one game-free day a week.   If problems arise, collect all electronic equipment at bedtime. If needed, use a computer surveillance program to monitor all aspects of your child’s electronic use.

Conclusion: Keep your nose to the laptop, your hand on the mouse, and your eyes on the screen. Above all, don’t worry if you blink. If you do, the electronic world is stored above your head in a celestial blue mist called, “the Cloud.” 

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.