Just as not everyone who drinks alcohol becomes an alcoholic, not everyone who plays an MMORPG develops problematic behaviors or addiction. Although all ages, sexes, and social and cultural groups are susceptible to MMORPG addiction, persons born between 1977 and 1997 are most vulnerable. These young people have grown up with access to computers, video games, and the Internet. Time online may be spent in chat rooms, playing online games, surfing for information, instant messaging, or just checking email. Regardless of the activities one pursues online, staying online the equivalent time of a full-time job for nonessential purposes could lead to problems with one’s ability to function in other areas of life. Work, relationships, responsibilities, and even personal health and hygiene may be neglected by persons who are unable to control the amount of time spent in on-line activities. The line between healthy and pathologic behaviors has historically been described as when the performance of life activities becomes problematic, whether this relates to drugs, alcohol, gambling, sex, shopping, eating, or any activity. Persons with addiction to MMORPGs or their loved ones may present to health care providers. Whether the psychiatric symptoms precede MMORPG use or are a consequence of it, the result is the same. Game players who spend excessive amounts of time in virtual worlds have symptoms similar to persons with other addictions. They may get restless or irritable if they are unable to play. They may sacrifice time from family, friends, and work. They may spend increasing amounts of time playing and may totally lose track of the time. Some gamers describe entering a “zone” as a flow experience where hours may seem like seconds. Persons who experience this phenomenon appear more prone to addiction. These persons may lie about or misrepresent time spent playing. They may lose interest in other activities and continue to play despite negative consequences. According to Yee, more than 40% of players consider themselves addicted to MMORPGs and 4.8% to 30% have made unsuccessful attempts to stop playing.
The high percentage of psychiatric comorbidity in the substance-abusing population is well known. The percentage of comorbidity with Internet addiction is also the subject of research and thus not known at this time. Mood disorders, attentional disorders, and substance dependencies are cited as comorbidities. More specific information is available in Table 2. When comorbid disorders are addressed concurrently, patient outcomes are greatly improved.
Table 2 -Psychiatric Disorders Most Commonly Comorbid with Internet Gaming Addiction
- Depressive disorders
- Bipolar disorders
- Substance-induced mood disorder
- Social phobia
- Generalized anxiety disorder
- Anxiety disorder NOS
- Attention deficit disorder
- Attention deficit hyperactivity disorder
Substance Use Disorder
- Amphetamine (or amphetamine-like) abuse or dependence
- Cocaine abuse or dependence
- Cannabis abuse or dependence