Conditions for Further Study 797
mal obligations, such as  school or work, or family obligati ons are neglected. This condition is
separate from gambling disorder involving the Internet because mo ney is not at risk.
The essential feature of Internet gaming di sorder is persistent an d recurrent participa-
tion in computer gaming, ty pically group games, for many hours. These games involve
competition between groups of players (often in  different global regions, so that duration
of play is encouraged by the time-zone inde pendence) participating in complex structured
activities that include a significant aspect of social interactions during play. Team aspects
appear to be a key motivation. Attempts to di rect the individual toward schoolwork or in-
terpersonal activities are strongly resisted. Thus personal, family, or vocational pursuits
are neglected. When individuals are asked, the major reasons given for using the com-
puter are more likely to be “avoiding boredo m” rather than communicating or searching
for information.
The description of criteria rela ted to this condition is adapt ed from a study in China. Un-
til the optimal criteria and threshold for di agnosis are determined empirically, conserva-
tive definitions ought to be used, such that diagnoses are considered for endorsement of
five or more of nine criteria. 
Associated Features Supporting Diagnosis 
No consistent personality types associated with  Internet gaming disorder have been iden-
tified. Some authors describe associated diagnoses, such as depressive disorders, atten-
tion-deficit/hyperactivity disorder (ADHD) , or obsessive-compulsive disorder (OCD).
Individuals with compulsive Internet gaming have demonstrated brain activation in spe-
cific regions triggered by exposure to the Internet game but not limited to reward system
structures
Prevalence
The prevalence of Internet gaming disorder is unclear because of the varying question-