video game addiction video game addiction video game addiction (vga), also known as gaming disorder or internet gaming disorder, is generally defined as a psychological addiction that is problematic, compulsive use of video games that results in significant impairment to an individual's ability to function in various life domains over a prolonged period of time. this and associated concepts have been the subject of considerable research, debate, and discussion among experts in several disciplines and has generated controversy within the medical, scientific, and gaming communities. such disorders can be diagnosed when an individual engages in gaming activities at the cost of fulfilling daily responsibilities or pursuing other interests without regard for the negative consequences. as defined by the icd-11, the main criterion for this disorder is a lack of self control over gaming. video game addictionother namesgaming disorder, internet gaming disorder, problematic online gamingsymptomsproblem gambling, depression, social withdrawal, playing video games for extremely long periods of timecomplicationsmood disorders, depression, somatisation, sleep disturbances, obesity, anxiety disordersrisk factorspreexisting mental disorder (adhd, ocd, compulsive behavior, conduct disorder, depression, behavioral inhibition), personality traits (neuroticism, impulsivity, aggressiveness)frequency1–3% of those who play video games the world health organization included gaming disorder in the 11th revision of its international classification of diseases (icd). the american psychiatric association (apa), while stating there is insufficient evidence for the inclusion of internet gaming disorder in the diagnostic and statistical manual of mental disorders in 2013, considered it worthy of further study. controversy around the diagnosis includes whether the disorder is a separate clinical entity or a manifestation of underlying psychiatric disorders. research has approached the question from a variety of viewpoints, with no universally standardized or agreed definitions, leading to difficulties in developing evidence-based recommendations. definition and diagnosis in its report, the council on science and public health to the american medical association (ama) used this two-hour-per-day limit to define "gaming overuse", citing the american academy of pediatrics guideline of no more than one to two hours per day of "screen time". however, the esa document cited in the council report does not contain the two-hour-per-day data. american psychiatric association while the american psychiatric association (apa) does not recognise video game addiction as a disorder, in light of existing evidence, the organisation included video game addiction as a "condition requiring further study" in the dsm-5 as internet gaming disorder. video game addiction is a broader concept than internet gaming addiction, but most video game addiction is associated with internet gaming. apa suggests, like khan, the effects (or symptoms) of video game addiction may be similar to those of other proposed psychological addictions. video game addiction may be an impulse control disorder, similar to compulsive gambling the apa explains why internet gaming disorder has been proposed as a disorder:this decision was based upon the large number of studies of this condition and the severity of its consequences. ... because of the distinguishing features and increased risks of clinically significant problems associated with gaming in particular, the workgroup recommended the inclusion of only internet gaming disorder in section 3 of the dsm-5. some players become more concerned with their interactions in the game than in their broader lives. players may play many hours per day, neglect personal hygiene, gain or lose significant weight, disrupt sleep patterns resulting in sleep deprivation, play at work, avoid phone calls from friends, or lie about how much time they spend playing video games. the apa has developed nine criteria for characterising the proposed internet gaming disorder: pre-occupation. do you spend a lot of time thinking about games even when you are not playing, or planning when you can play next? withdrawal. do you feel restless, irritable, moody, angry, anxious or sad when attempting to cut down or stop gaming, or when you are unable to play? tolerance. do you feel the need to play for increasing amounts of time, play more exciting games, or use more powerful equipment to get the same amount of excitement you used to get? reduce/stop. do you feel that you should play less, but are unable to cut back on the amount of time you spend playing games? give up other activities. do you lose interest in or reduce participation in other recreational activities due to gaming? continue despite problems. do you continue to play games even though you are aware of negative consequences, such as not getting enough sleep, being late to school/work, spending too much money, having arguments with others, or neglecting important duties? deceive/cover up. do you lie to family, friends or others about how much you game, or try to keep your family or friends from knowing how much you game? escape adverse moods. do you game to escape from or forget about personal problems, or to relieve uncomfortable feelings such as guilt, anxiety, helplessness or depression? risk/lose relationships/opportunities. do you risk or lose significant relationships, or job, educational or career opportunities because of gaming? one of the most commonly used instruments for the measurement of addiction, the pvp questionnaire (problem video game playing questionnaire, tejeiro & moran, 2002), was presented as a quantitative measure, not as a diagnostic tool. according to griffiths, "all addictions (whether chemical or behavioral) are essentially about constant rewards and reinforcement". he proposes that addiction has six components: salience, mood modification, tolerance, withdrawal, conflict, and relapse. but the apa's nine criteria for diagnosing internet gaming disorder were made by taking point of departure in eight different diagnostic/measuring tools proposed in other studies. thus, the apa's criteria attempt to condense the scientific work on diagnosing internet gaming disorder. world health organization the world health organization (who) had proposed and later included "gaming disorder" in the 11th revision of the international statistical classification of diseases and related health problems (icd-11), released in june 2018, which was approved by the world health assembly in may 2019. the use and enforcement of icd-11 is expected to start on 1 january 2022. screening tools the first psychometric test to assess igd was the internet gaming disorder test (igd-20). this test includes 20 questions designed to assess the extent of problems caused by disordered gaming and the degree of symptoms experienced by gamers. the test was first published in a journal article published in the plos one journal on 14 october 2014. the internet gaming disorder scale–short-form (igds9-sf) is a short psychometric test to assess video game addiction according to the american psychiatric association framework for igd. recent review studies suggest that the igds9-sf presents with robust empirical and clinical evidence and is an effective tool to assess igd. moreover, the scale was adapted in several languages as spanish, chinese, czech, german, and many more. on 3 june 2019, a screening tool for gaming disorder, specifically as defined by the world health organization, called the "gaming disorder test" was published in a journal article. risk factors the internet can foster various addictions including addiction to gameplaying. addictive playing of mmorpgs is associated with negative effects, whereas normal play is not. younger people and men are more likely to experience a gaming disorder than older people and women respectively. research shows that the average age of a gamer is 30 years old, and 32% of players are under 18.adolescents are at a higher risk of sustaining video game disorder over time than adults. an international meta-analysis over 34 jurisdictions quantified the effect size of gender as small, with most effect in asia, lesser in europe and africa, and null in north america, and further finding that economic factors, internet availability, social norms and addiction-related health factors mediate the effect of gender, with nations with a greater gdp per capita having less differences in video game addiction between genders. comorbid psychiatric disorders act as both risk factors and consequences. indeed, there is a strong association between video game addiction and anxiety, depression, adhd, social phobia, and poor psycho-social support. adhd and its symptoms, such as impulsivity and conduct problems, also increase risks of developing video game disorder. although internet gaming disorder has a strong relationship with obsessive-compulsive disorder, it is not specific and internet gaming disorder is both phenomenologically and neurobiologically distinct, which indicates that internet gaming disorder is more characterized by impulsivity than compulsivity. familial factors appear to play an important role, although not well understood. some personality traits, such as high neuroticism, high impulsivity, and high aggressiveness are consistently significant predictors of internet gaming disorder, and combination of personality traits seem to play a pivotal role in the acquisition, maintenance and development of the disorder. mechanisms although there is much research since the 1980s on problematic online gaming use, the mechanisms are not well understood, due to inconsistent definitions used in studies. video game structure some theories focus on the presumed built-in reward systems of video games, such as compulsion loops, to explain their potentially addictive nature. the anticipation of such rewards can create a neurological reaction that releases dopamine in the body, so that once the reward is obtained, the person will remember it as a pleasurable feeling. this has been found to be similar to the neurological reaction of other behavioral addictions such as substance abuse and gambling disorder. mark griffiths has proposed another reason online video games are potentially addictive is because they "can be played all day every day." the fact there is no end to the game can feel rewarding for some, and hence players are further engaged in the game. addiction circuits in the brain long-term internet video/mobile game playing affects brain regions responsible for reward, impulse control and sensory-motor coordination. structural analyses shown modifications in the volume of the ventral striatum, possibly as result of changes in rewards, and video game addicts had faulty inhibitory control and reward mechanisms. video game playing is associated with dopamine release similar in magnitude to that of drug abuse and gambling, and the presentation of gaming pictures activates brain regions similarly to drug pictures for drug addicts. treatment studies which used fmri to monitor the brain connectivity changes found a decrease in the activity of the regions associated with cravings. although there are evidences that video game addiction may be supported by similar neural mechanisms underlying drug abuse, as video game and internet addictions reduce the sensitivity of the dopaminergic reward system, it is still premature to conclude that this addiction is equivalent to substance addictions, as the research is in its early stages. there is evidence of a dual processing model of digital technology addictions characterized by an imbalance between the reactive and the reflective reward systems. other studies shown increased difficulties in decision making in specific contexts, such as risky situations but not in ambiguous situations, and an increased preference for short-term rewards. although the number of neuroimaging studies on internet gaming disorder is rising, there are several methodological shortcomings, particularly in the inconsistency of psychometric assessments. furthermore, the conclusions on reduced inhibition should be moderated, as only one study included a functional control, which then showed no difference in inhibition. a meta-analytic review of the research concluded the evidence suggests video game addiction arises out of other mental health problems, rather than causing them. thus it is unclear whether video game addiction should be considered a unique diagnosis. management as concern over video game addiction grows, the use of psychopharmacology, psychotherapy, twelve-step programs, and use of continuing developing treatment enhancements have been proposed to treat this disorder. empirical studies indeed indicate that internet gaming disorder is associated with detrimental health-related outcomes. however, the clinical trials of potential treatments remain of low quality, except for cognitive-behavioral therapies, which shows efficacy to reduce gaming disorder and depressive symptoms but not total time spent. although there is a scientific consensus that cognitive-behavioral therapy is preferable to pharmacological treatment, it remains difficult to make definitive statements about its benefits and efficiency due to methodological inconsistencies and lack of follow-up. since efficacious treatments have not been well established, prevention of video gaming disorder is crucial. there is some simple and affective coping methods individuals effected by gaming addiction could incorporate into their everyday life, these strategies included; setting a time limit devoted to gaming, keeping technology out of an individuals bedroom to create a healthier environment, and participating in physical activities and exercise. some evidence suggest that up to 50% of people affected by the