Cognitive Connie
Understanding internet gaming disorder
Internet Gaming Disorder (IGD) was introduced in DSM-5 (2013) as a Condition for Further Study — a category reserved for phenomena that warrant clinical attention and further research before potential formal recognition as a disorder. It describes a pattern of persistent and recurrent use of internet games that results in clinically significant impairment or distress, as manifested by five or more of nine specified criteria over a twelve-month period.
01. Overview
The nine DSM-5 proposed criteria for IGD.
DSM-5 requires five or more of these nine criteria over twelve months, causing clinically significant impairment. The criteria parallel those used for substance-use disorders.
Preoccupation
Persistent preoccupation with gaming — thinking about previous gaming activity or anticipating the next session when not playing. Gaming becomes the dominant activity in daily life, crowding out other thoughts and interests.
Withdrawal symptoms
Irritability, anxiety, sadness, or restlessness when gaming is taken away or is impossible. These symptoms are psychological, not pharmacological — the withdrawal-like state reflects disruption of a habitual behaviour rather than physical dependence.
Tolerance
A need to spend increasing amounts of time gaming in order to achieve the same level of enjoyment or engagement. Parallels the pharmacological concept of tolerance, but operationalised in terms of time investment rather than dosage.
Loss of control
Unsuccessful attempts to reduce or control participation in gaming. The individual recognises that their gaming is problematic and wishes to reduce it, but is unable to do so consistently — a hallmark feature of compulsive behaviour patterns across addiction models.
Key figures
Mark Griffiths
1966–presentBritish psychologist and prolific researcher in behavioural addictions who has studied gaming disorder for over three decades. Griffiths developed the components model of addiction (salience, mood modification, tolerance, withdrawal, conflict, relapse) and has applied it extensively to gaming, arguing for the recognition of gaming disorder while emphasising that most heavy gamers are not disordered.
Christopher Ferguson
1970–presentAmerican psychologist and leading sceptic of IGD as a diagnostic category, arguing that the existing evidence is insufficient to support formal disorder recognition, that prevalence estimates are inflated, and that cultural moral panic around gaming has distorted the research agenda. His meta-analyses have consistently found smaller effect sizes for gaming-harm associations than those reported in primary studies.
Daria Kuss
active 2010s–presentPsychologist and researcher at Nottingham Trent University who has conducted systematic reviews and neuropsychological studies of IGD, contributing to the ICD-11 working group. Her work has emphasised the neurobiological similarities between IGD and substance addictions while advocating for rigorous, standardised assessment.
Key concepts
DSM-5 Condition for Further Study status
IGD appears in DSM-5's Section III (Emerging Measures and Models) rather than as a formal disorder in Section II. This status indicates that the construct has sufficient clinical and research interest to warrant attention and further investigation, but does not yet meet the evidentiary threshold for official disorder recognition. The ICD-11 (2022) went further and included Gaming Disorder as a formal diagnosis, creating a notable divergence between the two major classification systems.
Two-factor model
A framework distinguishing disordered gaming from engaged (passionate but non-disordered) gaming. The model proposes that the nine DSM-5 criteria cluster into two dimensions: loss of control and preoccupation (core addiction features) versus other criteria that may reflect high engagement rather than disorder. Empirical support for the two-factor structure has been inconsistent, with some studies finding a unidimensional structure and others supporting a more complex factor model.
Prevalence and heterogeneity
Prevalence estimates for IGD vary enormously across studies — from under 1% to over 10% depending on the population, country, measurement instrument, and diagnostic threshold used. This heterogeneity is itself a major methodological concern: without standardised assessment criteria applied consistently, prevalence figures are not comparable across studies and may not reflect a single underlying clinical entity.
Sensitivity and specificity
In diagnostic assessment, sensitivity is the ability of a test to correctly identify those who have the disorder (true positive rate); specificity is the ability to correctly identify those who do not (true negative rate). IGD screening instruments face a fundamental trade-off: thresholds sensitive enough to catch all cases tend to misclassify engaged but non-disordered gamers; thresholds specific enough to exclude false positives may miss genuine cases.
Executive functioning and impulse control
Multiple neuropsychological studies have found that individuals meeting IGD criteria show impairments in executive functions — particularly inhibitory control, cognitive flexibility, and decision-making under uncertainty. These deficits parallel findings in substance-use disorders and may reflect both a predisposing vulnerability and a consequence of prolonged heavy gaming. The prefrontal cortex, central to executive control, shows structural and functional differences in some IGD samples.
Emotion regulation
Heavy gaming frequently serves emotion-regulation functions: escapism from negative affect, anxiety, depression, or boredom. In individuals with IGD, gaming may function as a maladaptive coping mechanism that temporarily reduces distress but reinforces the pattern through negative reinforcement. High rates of comorbid depression, anxiety, ADHD, and social anxiety are consistently reported in IGD samples, raising the question of whether IGD is a primary disorder or a symptom of underlying emotional difficulties.
Behavioural addiction model
IGD has been conceptualised within the broader framework of behavioural (non-substance) addictions — a category that includes gambling disorder (the only formally recognised behavioural addiction in DSM-5). The addiction model holds that behavioural and substance addictions share common neurobiological mechanisms involving dopaminergic reward circuits, and that compulsive loss of control over an appetitive behaviour can constitute a disorder regardless of whether a psychoactive substance is involved.
Test your knowledge
Frequently asked questions
Is Internet Gaming Disorder a real diagnosis?+
It depends on which classification system you consult. IGD appears in DSM-5 (2013) as a 'Condition for Further Study' — meaning it is not formally recognised as a disorder but is flagged for clinical attention and research. The ICD-11 (2022), used internationally, went further and included 'Gaming Disorder' as an official diagnosis. The debate is live and methodologically substantive: critics argue that current criteria cannot reliably distinguish compulsive disorder from passionate engagement, while proponents point to neuropsychological data and real functional impairment in a subset of heavy gamers.
What are the DSM-5 criteria for Internet Gaming Disorder?+
DSM-5 proposes nine criteria: preoccupation with gaming; withdrawal symptoms when gaming is removed; tolerance (needing more time for the same effect); unsuccessful attempts to control gaming; loss of interest in other activities; continued gaming despite knowing it causes problems; deception about the amount of time spent gaming; use of gaming to escape or relieve negative moods; and jeopardising a relationship, job, or educational opportunity because of gaming. Five or more criteria over twelve months, causing significant impairment, would meet the proposed threshold — though this has not been formally ratified as a clinical standard.
How common is gaming disorder?+
Prevalence estimates vary enormously — from under 1% to over 10% of gaming populations — depending on which screening instrument is used, which threshold is applied, and which country or age group is studied. This variability is itself one of the central concerns about the IGD construct: without a standardised, validated diagnostic instrument applied consistently, it is impossible to know how many people genuinely meet clinical criteria. Most researchers agree that the severe end of the spectrum — where gaming causes clear functional impairment across multiple life domains — affects a small minority of gamers.
What brain changes are associated with gaming disorder?+
Neuroimaging studies of individuals meeting IGD criteria have found differences in prefrontal cortical activity (associated with executive control and inhibition), reward-circuit reactivity to gaming cues, and grey-matter volume in regions implicated in impulse control. These findings parallel results from substance-use disorder research. However, most studies are cross-sectional — meaning we cannot tell whether these neural differences predate gaming disorder (and thus represent a vulnerability) or emerge as a consequence of heavy gaming over time. Longitudinal studies are needed to resolve this question.
What is the difference between ICD-11 gaming disorder and DSM-5 IGD?+
The ICD-11 (World Health Organization) formally recognises 'Gaming Disorder' as a clinical diagnosis characterised by impaired control over gaming, increasing priority given to gaming over other activities, and continuation or escalation of gaming despite negative consequences — persisting over at least twelve months. DSM-5 (American Psychiatric Association) includes Internet Gaming Disorder only as a 'Condition for Further Study', not a formal diagnosis. The ICD-11 also allows for offline gaming disorder, while DSM-5's proposal specifies internet-based gaming. The two systems' criteria substantially overlap but reflect different institutional judgments about the sufficiency of current evidence.
Sources
Last reviewed July 2025- 1.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA Publishing.
+About this source
Includes Internet Gaming Disorder as a condition for further study, establishing provisional diagnostic criteria.
- 2.
World Health Organization. (2019). International Classification of Diseases, 11th Revision (ICD-11). WHO.
+About this source
Formally included Gaming Disorder as a clinical diagnosis under addictive behaviours.
- 3.
Kuss D.J. & Griffiths M.D. (2012). Internet gaming addiction: A systematic review of empirical research. International Journal of Mental Health and Addiction, 10(2), 278–296.
+About this source
Systematic review of empirical studies examining problematic gaming and its psychological correlates.