Computers are used by many persons in all aspects of their work and personal lives. The Internet has made universal networking possible. Information is available 24 hours a day in all areas of interest for education, communication, and entertainment, much to the benefit of society.

However, the pursuit of information, the ability to communicate instantly with others, and the immersion into virtual gaming worlds may lead to problems in the real world if an excessive amount of time is spent online. The amount of time necessary to hone skills to play at a level required to advance in these games can be excessive.

Whether the term used is problematic computer use, online game addiction, computer addiction, or Internet addiction, this problem is not currently recognized as an official disorder by the American Psychiatric Association. Little information is available to guide diagnosis and management. Although what to call the problem and how to treat it are controversial, the literature about computer-related problematic behaviors has grown exponentially as the number of those affected increases. Researchers have proposed diagnostic criteria and created screening tools to help in the diagnosis of the problem. M Griffiths, Technological addictions, Clin Psychol Forum 76 (1996), pp. 14–19. Research in this area is still in the preliminary stages because few clinical trials and no meta-analyses have been done to evaluate treatment for this type of addiction. A review by Widyanto and Griffiths reports treatment recommendations based on case studies. Del’Osso et al discuss treatment options for compulsive-impulsive Internet usage disorder along with other impulse control disorders and treatment options based on some clinical trials. For now, most clinicians are treating the problem as a subtype of an impulse control disorder.

In defining addiction as compulsion to use, a brain disease, and a chronic medical disorder, Kleber and Galanter speak primarily of addiction to drugs. However, other behaviors with excessive involvement in activities such as gambling, compulsive shopping, sex, and eating are also labeled as addictions.

Problematic computer usage appears to be affecting patients worldwide. In Korea, a government agency was created to address the growing problem. The Chinese government has placed a ban on the opening of new Internet cafes and has opened a treatment center for citizens with Internet-related problems at Beijing Military Region Central Hospital. The Illinois Institute for Addiction Recovery at Proctor Hospital; the Impulse Control Disorders Clinic at Stanford University; the Computer Addiction Services of McClean Hospital; Smith & Jones Addiction Consultants in Amsterdam; The Center, Inc., with locations in Washington state and Ecuador; and the Center for Online Addiction (COLA) at the University of Pittsburgh, Bradford Campus, are some of the specialized treatment centers addressing these types of problems. Web sites have also been developed to provide information and support for gamers and their families and friends.

Role-playing games from the early tabletop versions to MMORPGs are linked to controversy. In the 1980s, the game Dungeons and Dragons was thought to be linked to Satanism, suicides, and cultlike activities. MMORPGs are similarly being scrutinized.

MMORPGs are a genre of online games. Glossary of relevant terms are defined in Table 1. The actual term MMORPG was reportedly coined in 1998 by those responsible for introducing the MMORPG “Everquest.” No person is noted with being the first to use the term. A game’s creators design elaborate, detailed fantastical virtual worlds that are inhabited by single players who create their own characters and form networks or guilds with other players within games to achieve common goals, fight enemies, live and work in communities, and accumulate points with which they buy skills, weapons, or other accessories. A game’s storyline evolves in real time, and, although guided by the game’s creators, the players themselves make many decisions. With players around the world, any game can be played 24 hours a day. Players only have input when actually online, leading many to be reluctant to leave the virtual environment to take care of routine tasks of daily living. In addition, many of these games charge monthly subscription fees that add to the cost of the original software. Legitimate revenues for MMORPGs in 2006 reached the billion-dollar mark with a forecast for continual exponential growth. Role-playing games account for approximately 14% of the computer and video game industry that as a whole amassed $7.4 billion in sales in 2006. Some gamers choose to buy or sell items and characters through various methods not sanctioned by the software companies.