Gaming Disorder: Clinical Diagnosis, Neurobiological Underpinnings, and Therapeutic Approaches
Dheepthi Kabilan *
Motherhood Hospital, Banashankari, Bangalore, Karnataka, India.
*Author to whom correspondence should be addressed.
Abstract
Gaming disorder has emerged as a clinically significant condition characterised by persistent and recurrent engagement with digital games to the extent that gaming takes precedence over other life interests and daily activities. Its formal adoption by the World Health Organization in the 11th revision of the International Classification of Diseases (ICD-11) at the 72nd World Health Assembly in May 2019, entering into international effect on 1 January 2022, marked a pivotal moment in behavioural health by distinguishing pathological gaming from recreational use and situating it within the broader spectrum of addictive disorders. This chapter focuses on gaming disorder as a clinically recognised behavioural addiction characterised by persistent and recurrent engagement in digital gaming that results in significant impairment in personal, social, and occupational functioning. This narrative review synthesises current evidence concerning the clinical diagnosis, neurobiological mechanisms, epidemiological profile, and therapeutic strategies associated with gaming disorder. Literature was sourced by conducting searches across major academic databases. Drawing upon research published between 2000 and 2026, as well as foundational earlier works, the review examines diagnostic criteria proposed under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and ICD-11, explores the neurobiological correlates including reward pathway dysregulation, dopaminergic dysfunction, and structural brain alterations, and considers the psychological models that have sought to explain its aetiology. Epidemiological evidence indicates that prevalence rates vary substantially across populations and measurement approaches, with adolescent males disproportionately affected. Comorbidities, including depression, anxiety, and attention-deficit/hyperactivity disorder, are frequently documented. Therapeutic evidence, while still maturing, points to cognitive-behavioural therapy as a first-line psychological intervention, with pharmacotherapy demonstrating early promise in selected populations. This review highlights unresolved definitional debates, methodological inconsistencies in epidemiological research, and the urgent need for standardised, culturally sensitive assessment frameworks and evidence-based treatment protocols. Longitudinal studies are particularly needed to clarify the temporal relationship between excessive gaming and associated psychiatric comorbidities, including whether conditions such as depression, anxiety, and Attention-Deficit/Hyperactivity Disorder (ADHD) act as precursors, consequences, or bidirectionally related factors.
Keywords: Internet gaming disorder, behavioural addiction, ICD-11, DSM-5, neuroimaging, cognitive-behavioural therapy, dopamine, reward system