Internet is undoubtedly a remarkable invention. When used properly with good intention, it has great technological value in research, communication, information, leisure activities, business transactions, and learning. However, there is always a dark side to new technologies. In case of Internet, it turns to an addiction which is a recent concept and still under research. Internet gaming addiction is the latest phenomenon in the world of Internet (
5). For many adolescents, spending time on the computer means playing online video games. A market research company has estimated the China’s worth online gaming market as $12 billion in 2013. A recent review article reported prevalence estimates ranging from 0.2% in Germany to 50% in Korean teenagers ( 6).
Although Internet gaming disorder has not been classified under main disorders of DSM-5, researchers have realized that Internet gaming is increasingly being used by people of all ages, especially younger population, who may face severe consequences associated with compulsive use of games (
6). According to DSM-5 ( 4), Internet gaming disorder refers to the “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by 5 (or more) criteria in a 12-month period.” These criteria comprise lack of control over the use of Internet games, preoccupation with Internet gaming, psychological withdrawal, developing tolerance for games and need for increase use of games, loss of other significant interests, use of Internet games despite negative consequences, and significant decline in social and occupational domains ( 4, 6). All these signs and symptoms were observed or reported in the described case report of patients. Internet gaming addiction is a disorder that is most dramatically expressed with games known as massively multiplayer online games (MMOs) ( 7) and specially massively multiplayer online role-playing games (MMORPGs) like World of Warcraft ( 8). MMORPGs are games played by thousands of players at the same time (massively multiplayer). Because these games are played online, there are no spatial or temporal boundaries and they allow players to adopt various virtual roles. MMORPGs utilize the principles of operant conditioning by using highly reinforcing random reward patterns. Hence, these games are specially engineered to maximize the amount of time a player stays in the game. The same was observed in the patients where they used to play such games with virtual friends across different countries and at odd hours.
There is a growing concern about several negative consequences associated with Internet gaming addiction. The psychological consequences vary and include difficulty in real-life relationships, disturbances in sleep, work, education, socializing, attention, academics, and memory. It may include aggression and hostility, stress, and high loneliness (
6, 9- 11). Most of these disturbances were evident in both patients.
Considering the shared features with addiction disorders, which are evident from the above case, Internet gaming addiction could be placed alongside the main disorders in the future classificatory systems. DSM-5 needs to consider the severity classifiers for the disorder, which might present variedly depending upon the content and type of games, cultural context of gaming, and associated personality type. Internet addiction is a new and emerging group of disorders in Indian subcontinent (
12). It has proliferated and spread across the subcontinent, in spite of deeply knit family systems and parental supervision. Systematic studies need to be undertaken in Indian subcontinent to evaluate the prevalence and type of gaming addiction. Crucial steps in curtaining this evolving epidemic must be taken in the form of legal limitations on sale/purchase, setting the age limit, and restricting access to online games.