Is it possible to become addicted to gaming on the internet?
Yes, warns new research that discovered when young people get too hooked it may trigger sleep difficulties, depression, anxiety and, in some cases, even suicidal thoughts.
Phone interviews conducted among nearly 3,000 American college students between 2007 and 2015 revealed that roughly one in 20 had "internet gaming disorder," a clinical condition defined by the compulsive use of electronics, both online and offline.
"Like with any addiction, to be considered a disorder, internet gaming must cause disturbances in daily life," explained study author Dr. Maurice Ohayon, director of the Stanford Sleep Epidemiology Research Center at Stanford University in Palo Alto, Calif.
One example: "Playing [online] until late in the night, and then having difficulties to get up in the morning to go to class or to work, or simply skipping classes," Ohayon said.
Ohayon also found that the behavior was linked to a higher-than-normal risk for "feeling unrested when they wake up, being fatigued, feeling depressed, and having social anxiety."
Does that definitively mean that gaming disorder directly causes poor mental and physical health? No, said Ohayon, who cautioned that not enough is known about the disorder, and "causality cannot be inferred."
Still, he and his colleague found evidence that "many elements -- such as feeling depressed, social anxiety, having very few friends, being unhappy with social life, and suicidal [thoughts] -- pointed to social isolation or loneliness among students with internet gaming disorder."
The study authors noted that 90% of American households are now connected to the internet, with teens and young adults among its biggest users.
Starting in the late 1990s, researchers began looking into the potential downside of heavy internet use. Back in 2013, that concern prompted the American Psychiatric Association to include internet gaming disorder as an official diagnosis in its updated diagnostic manual.
But what exactly separates excessive internet use from a true addiction remains a matter of debate. "Right now," Ohayon said, the manual has put internet gaming disorder in the section of diagnoses that need further investigation "because it is a relatively recent problem, and we still have insufficient data."
That might explain why internet gaming disorder estimates range widely, with prevalence in the United States pegged as low as less than 1% to as high as more than 9%.
To get a better handle on the true extent of the problem, the team focused on a pool of Stanford University students.
Student interviews lasted about 75 minutes, on average. Internet gaming disorder was diagnosed only if a student reported using the internet and/or an electronic device for at least 15 hours per week and indicated at least five ongoing behavioral issues.
Those included: missing or being late for class; feeling guilty about internet habits; loss of ambition or efficiency; behaving carelessly; having trouble sleeping; increasingly jumping online after feeling argumentative, disappointed or frustrated; going online to "escape" feeling worried; or lying about their internet habits.
The team found that 5.3% of those interviewed had the disorder, with overall risk appearing to be slightly -- but not significantly -- higher among boys.
The findings were published online recently in the journal Psychiatry Research.
One psychiatrist not involved in the study described the investigation as "an extremely well-done study, and very helpful to our field."
But "as is the case with any form of addiction, it's important to know that not everyone who enjoys using the internet will develop an addiction. Just like the vast majority of people who drink alcohol will not become alcoholic," stressed Dr. Petros Levounis, chair of the department of psychiatry at Rutgers New Jersey Medical School.
"But there is a significant number of people who will," he acknowledged, although why some fall prey to internet gaming disorder is not always clear.
"Some kids may have socializing issues that lead them to spend more time online; some might develop problems because of the time they spend online," Levounis said. "But it's not necessarily the chicken or the egg. It can be both."
Either way, having internet gaming disorder means that "they will always think about it," Levounis said. "They will crave being online, they will spend inordinate amounts of time online, and they may try to cut down but find that they're not able to. They know it's bad, but they just can't stop."
And that, he added, "can have serious consequences. Your job, your studies, your grades start suffering. Your interpersonal relations start going south, and you stop having other interests or hobbies."
As to what can be done, Levounis said the interventions "are very similar" to what would be done when dealing with any kind of addiction. "Except we don't have specific medications for this," he noted. "So the work will largely involve cognitive behavioral therapy and counseling to help motivate the patient to change their behavior."
There's more on internet gaming disorder at the American Psychiatric Association.
SOURCES: Maurice Ohayon, MD, DSc, PhD, professor, psychiatry and behavioral sciences, and director, Stanford Sleep Epidemiology Research Center, Stanford University, Palo Alto, Calif.; Petros Levounis, MD, MA, professor and chair, department of psychiatry, Rutgers New Jersey Medical School, and chief of service, University Hospital, Newark, N.J.; Psychiatry Research, June 6, 2021, online