Thomas is a 14-year-old boy in psychiatric treatment for depression and anxiety. Although his symptoms have partially responded to cognitive-behavioral therapy (CBT) and medication, Thomas continues to experience self described “panic attacks” that occur only at school.
When not at school, Thomas spends essentially all of his time on the Internet, playing video games and on Facebook. He spends anywhere between five and 10 hours online on an average day, going to bed at 3 a.m. frequently. Weekends are worse. Thomas consistently chooses video games and the Internet over other activities and insists that his involvement with these activities is “normal” despite significant difficulties with school attendance, academic performance, and peer relationships.
His parents eventually enroll him in an online school to manage the school problems. Despite multiple attempts and promises to decrease his use, Thomas continues to incessantly be online, mostly playing video games on his computer and smartphone.
The above scenario is an excerpt from a real case. Unfortunately, Thomas is one of the many teenagers in the U.S., and globally, who suffer from Internet and gaming addiction. Prevalence rates range between 1 and 18% worldwide1, with females showing a significantly lower rate of addiction (up to 10 times lower). In the U.S., they range anywhere between 1.5 and 8.2%13, with 97% of all teenagers in the U.S. playing video games for recreation3.
Moreover, survey data from a few years ago has shown the growth of general Internet usage at a rate of 25% every 3 months, with almost 90% of all Americans now connected to the Internet4. According to recent statistics, young males primarily plays sports games (such as FIFA/soccer) and combative games (e.g. Call of Duty), with music simulation (e.g. Guitar Hero) and life management games (such as The Sims) being less popular. In females, these ratios are essentially reversed2.
The DSM-V has proposed “Internet Gaming Disorder” as the diagnosis for teens such as Thomas, and describes it as a “persistent and recurrent use of the Internet to engage in games,” leading to psychosocial problems and withdrawal symptoms, such as irritability, anxiety and sadness (akin to gambling and substance abuse) when Internet access is denied6.
Although initially humorously described by Ivan Goldberg in 199511,12, it has become clearer in the last few years that Internet Addiction Disorder (IAD) entails significant deleterious effects for our youth. In addition to excessive Internet use and possible addiction, children and adolescents are now increasingly exposed to online risks such as gambling, pornography, sexual solicitation and harassment (cyberbullying).
In addition to IAD, several other terms have been used interchangeably to describe overuse of the Internet, such as Compulsive Internet Use (CIU), Problematic Internet Usage (PIU) and Pathological Internet Use (PtIU)7. Recent studies from China on elementary school children have shown a correlation between PIU and the symptoms of ADHD, such as a lack of focus9. Additionally, there is increasing interest in exploring possible links between video games and psychiatric disorders such as bipolar disorder, depression and social anxiety1,10.
There has been considerable research on the possible impact of violent video games with consistent hypothesis that playing these types of games may contribute to aggressive behavior and personality styles through role modeling, reducing feelings of empathy and increasing tolerance to violent thoughts, images and scripts5. Recent studies have shown that overuse of most media (Internet, video games, mobile phones) may play a role in the increased incidence of depression and social anxiety in the adolescent population1,10.
International studies have proposed a genetic link between PIU and depression by identifying anomalies in the serotonin transporter genes in such individuals, whereas others have shown a correlation between PIU and low emotional intelligence7 and impulsivity8.