Internet gaming disorder  

Master Rachit (name changed), 12 years male, resident of New Baneswor was brought to our counselling center with complaints of episodes of hyperventilation, foreign body sensation in throat, feeling of tightness in chest, fearfulness, palpitation and disturbed sleep of 1 month duration. 

Rachit is a student of grade nine and is average at his studies. His parents have noticed that for few months he has been more involved with internet games. He started using internet for his project works of school. Gradually he started using it for online gaming. 

These days he has been spending most of his time playing those games. He even bought online game from nearby cyber. He rationalises that his money will be a loss if he doesnt play it. 

His parents tried to convince him and even disconnected internet, but the consequenses were more dread. In absence of internet games he began having above mentioned symptoms. Besides he began to be irritable and agressive towards his parents; sometimes abusing them physically. He also exhibited temper tantrums by rolling in ground, crying, banging his head against wall. 

We had long discussion among his parents, clinical psychologist and psychiatrist and made a provisional diagnosis of "internet gaming disorder". 

Individuals with internet gaming disorder spend almost their waking hours in internet playing different games. Their behavior is repetitive and they are unable to resist strong urges to use internet for gaming. 

Clinically internet gaming disorder is defined as having at least 5 of the following signs and symptoms.

1. Preoccupation with internet gaming 
2. Increasing amount of time spent for online gaming
3. Failure to cut back/ stop using
4. Restlessness and anger outburst in absence of access to internet games
5. Declined performances in academics and job; poor interpersonal relations
6. Lying to conceal extent of internet gaming

Continued use of internet gaming may herald the onset of anxiety, depression and psychosis. 

Associated conditions may include: 

• Internet addiction
• Cybersex addiction- viewing pornography
• Cyberrelational addiction- establishing online relations and giving more preferences than real relations
• Gambling addiction 

Treatment approaches include: 

1. Behaviour oriented approach
2. Cognition oriented approach
3. Psychopharmacology
4. Treatment of comorbid conditions