Some have argued that the proliferation of personal computers and the widespread use of the Internet have greatly benefited society. However, a recognized problem occurs as persons spend excessive amounts of time online, which may lead to problems in other areas of their lives. Peer-reviewed articles and articles in the media have shown massively multiplayer online role-playing games to be one area of concern. All health care providers should be aware of how to recognize and treat this potential problem. To date, few randomized controlled trials have been conducted to evaluate treatment for this type of addiction.

Keywords: Internet addiction; Internet gaming addiction; massively multiplayer online role-playing games; online gaming

Bill, a 30-year-old college-educated man, seeks treatment because his wife thinks he should have a psychiatric evaluation. Her main concern is the amount of time he spends in the virtual world of the massively multiplayer online role-playing games (MMORPG).

Jim, a 41-year-old computer programmer, seeks treatment for severe depression and suicidal ideation. His wife of 13 years is having an online affair in an MMORPG.

Michelle, a 39-year-old recovering alcoholic, seeks treatment for depression worsened by the long periods of time her fiance’ spends playing an MMORPG with his brother.

George, a 27-year-old, who is employed off and on and lives with his mother, seeks treatment after repeatedly being found “passed out” in front of the computer. He has used methamphetamines to stay awake for extended periods (up to 32 hours) to play an MMORPG. He has a history of obsessive behaviors and depressive tendencies along with alcohol and drug abuse.

As one can see, assistance is sought by gamers or those who care about them. This is only a brief description of four patients seen in practice and their presenting problems. At the end of the article, a brief synopsis of their treatment and outcomes is provided.

Introduction

The term internet addiction was first used in 1995 when New York psychiatrist, Ivan Goldberg, described it as a joke to a group of psychiatrists with whom he communicated with online. This addiction was formally presented by Kimberly Young at the 1996 American Psychological Association’s annual convention. Although Goldberg (personal communication, March 2007) and others believe the problem to be a symptom of an impulse control disorder, Young likens Internet addiction to other addictions in that it can cause a loss of control, social isolation, problems in marital and family relationships, and educational or employment problems. Her research has described cravings and physical withdrawal symptoms.

A press release from the American Psychiatric Association dated June 21, 2007, stated that, although it does not currently view any type of “video game addiction” to be a mental disorder, it would use the “latest and best science” when the association compiles the new edition of the Diagnostic and Statistical Manual (DSM) for publication.

Background