Gaming disorder (internet gaming disorder): signs, assessment and NHS help

Gaming is an ordinary and often sociable activity. The National Centre for Gaming Disorders says that, like most activities, gaming can be a great way to relax, destress and socialise, but that for a minority of people excessive gaming can have a negative impact on them and those around them.

The WHO describes gaming disorder in ICD-11 as a pattern of digital or video gaming behaviour with three features: impaired control over gaming, increasing priority given to gaming over other interests and daily activities, and continuation or escalation of gaming despite negative consequences. The term internet gaming disorder is used in some research and classification systems; this guide uses gaming disorder as the NHS and WHO do, and the descriptions here are drawn from their material.

The amount of time spent is not the test. Someone can play for many hours and remain well, working, sleeping, eating and keeping up friendships. It is the loss of control and the harm that define the problem.

NHS England describes gaming disorder as a person struggling to control how often they play video games, which can be up to fourteen hours a day or more, with some cases resulting in violence, avoiding school and work, breakdown in family relations and general withdrawal from society. The National Centre for Gaming Disorders asks people to consider questions such as the following.

• Do you spend too much time and money on games despite attempts to stop?

• Are you spending less time with friends or family?

• Is gaming affecting studies, family time, going out or other hobbies?

• As a parent or carer, are you worried about how much someone plays and what it is doing to their life?

Help is worth seeking when gaming is regularly taking precedence over school, work, sleep, relationships or health, when attempts to cut down repeatedly fail, or when stopping leads to marked distress or aggression. NHS England quotes the centre's director saying that, as with other addictive and mental health disorders, the earlier it is identified and treated the more successful the outcomes will be for the individual and for family members.

A GP is a good first contact and can refer to local services or the national centre, and the centre also accepts self-referrals. It says it does not offer crisis interventions; if someone is in crisis, contact a GP, a community mental health team or A&E, or the police if there is risk. Call 999 in an emergency.

The sources used here do not set out a single cause, and it is not a matter of weak character or poor parenting. People may use gaming to escape stress, low mood, loneliness or conflict, and games are designed to reward continued play. Gaming disorder can occur alongside anxiety, depression, ADHD or autism, so a wider mental health assessment is often valuable.

The WHO says that people who play should be alert to the amount of time they spend gaming, particularly when it is to the exclusion of other daily activities, and to changes in physical or psychological health and social functioning that could be attributed to their pattern of gaming.

The WHO says that for a diagnosis the behaviour pattern must be severe enough to result in significant impairment in personal, family, social, educational, occupational or other important areas, and would normally have been evident for at least 12 months. The National Centre for Gaming Disorders describes a comprehensive consultation with the person who games, and says it works jointly with mental health teams.

Assessment looks at what is being played, how long and when, spending, sleep, school or work, mood, anxiety, other behaviours and what has been tried. Family members are often involved, especially for younger people.

The National Centre for Gaming Disorders is a multi-disciplinary NHS clinic in London that provides support for people in England aged 13 and over who are experiencing difficulties controlling their video game use. NHS England says treatment delivery is mainly online, so people do not have to travel. Its services include a comprehensive consultation, individual or group treatment, parent workshops, a peer support group, family therapy and support for family members.

The centre says its therapy is CBT focused on controlled levels of gaming and increasing other activities, with a focus on gaining more control over gaming so that it does not take over other areas of life and feels more balanced. It supports parents and carers of young people aged 13 to 16, and says that due to demand it currently only considers parent or carer referrals for young people aged 16 or under. NHS England reported that 745 people had been referred since the centre opened in October 2019, as of March 2023.

For parents, a calm conversation about the effects of gaming, rather than a ban imposed in the middle of an argument, tends to work better. Agreeing predictable limits together, keeping devices out of bedrooms at night, protecting sleep and meals, and encouraging other activities all help. The health minister quoted by NHS England says prevention includes recognising the warning signs and monitoring online activity if you are worried.

Withdrawal of a device can provoke anger. If aggression, self-harm threats or school refusal are part of the picture, speak to a GP or the school rather than managing it alone.