Digital Dependency: Tips for Diagnosis, Screening, and Management of Gaming Disorders

A 16-year-old patient, H.C., presents to the clinic for a routine wellness examination. When I entered the examination room, the patient was playing a game on his portable gaming console. Having grown up playing the same series, I engaged him in small talk about this shared interest. The patient briefly glanced at me, then immediately returned to his game, stating he must “beat this level.” His parents then removed the gaming console and lightly scolded him before the visit officially began. Overall, H.C. is healthy, without significant medical history; however, he admitted to playing digital games for at least 6 to 8 hours daily. He reported that he rarely took breaks and did not engage in other hobbies. H.C.'s parents expressed concern that he was gaming too much, and they wondered what they could do to help him focus less on playing games and more on academics and future goals. As both a physician and player of video games, how can I help H.C. achieve a balance between gaming and other parts of life (eg, school, work, hobbies, social interaction, physical activity)?

The extended reach of the internet, technical innovations, improved device power, connectivity, and portability have allowed the video game industry to become increasingly accessible and profitable. More than 500 million gaming consoles have been sold to an ever-growing player base.¹ Meanwhile, mobile and personal computer gamers have regularly eclipsed more than 2 billion participants, 80 billion game downloads, and $100 billion in global revenue.^2,3 In 2025, nearly two-thirds of the US population (205.1 million) play video games, including 83% of Generation Alpha (ages 5 to 12) and 60% of adults (ages 18 and older).⁴ Although global data vary based on culture, demographics, and socioeconomics, increased online accessibility and global reach of consoles and devices indicate such numbers will likely increase in the future.²

When used as a healthy medium, gaming has shown to have several potential benefits. Recreational gaming with friends and family can help foster a sense of community, strengthen interpersonal relationships, and enable long-distance socialization through online services.³ It can also serve as a temporary stress reliever and respite from real-world problems.^3,5,6 This was especially exemplified during the COVID-19 pandemic, where individuals commonly turned to devices and media as coping mechanisms in response to worldwide lockdowns.⁵ Other research has shown improved cognitive processing, task management, and learning or education with certain game genres; however, the quality of such studies is still limited.^3,5,6

More critically, unrestricted gaming and screen time can lead to dependence and eventual addiction. Adolescents, especially those with corresponding developmental disability or mental health disorders (eg, attention-deficit/hyperactivity disorder, anxiety, depression) are at heightened risk, with nearly 50% reporting addictive screen tendencies in the United States alone.⁷

Preoccupation with gaming and screen time during critical periods of development can affect neurobiological pathways that control reward and pleasure.^3,8 Decreased thresholds for stimulation and satisfaction cause individuals to crave more time playing games on devices, diverting their focus from real-world resposibilities.⁸ This can lead to poor grades, failed academic performance, loss of self-control, emotional difficulty, neurocognitive impairment, and nomophobia (ie, fear of time away from devices).^3,7–9 Studies have shown increased risk of worsening mental health and suicidal ideation with addictive video game use in early adolescence.^7,10 Associated comorbidities also include poor dietary and lifestyle habits, dry eye, insomnia, and obesity.^3,6–10