Gaming Disorder: A Deeper Look into Its Causes and Complexities Insights from the 2023 Review by Király et al. (part - 1)

As gaming becomes increasingly integrated into everyday life, concerns about gaming disorder (GD)—now recognised by the World Health Organisation (WHO) in the ICD-11—continue to grow. But what leads a leisure activity enjoyed by billions to become a source of mental health impairment for some?

A 2023 comprehensive review by Király, Koncz, Griffiths, and Demetrovics, published in Comprehensive Psychiatry, synthesises decades of research and provides a structured model for understanding GD’s development and persistence. The article outlines three key interacting factors: game-related mechanisms, individual vulnerabilities, and environmental influences. Each of these domains plays a distinct but interconnected role in the emergence of gaming-related problems.

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Images from Muhammad Sadeeq at Pixabay

1. Gaming-Related Factors: Design Meets Psychology

Structural and Social Features

Games are not neutral tools; they are carefully engineered systems designed to maximise engagement. Features that increase the addictive potential of games include:

  • Online multiplayer dynamics, which enhance social immersion.
  • Game genres with high involvement, such as MMORPGs (massively multiplayer online role-playing games), MOBAs (multiplayer online battle arena), and FPS (first-person shooter) games.
  • Structural reinforcements like reward systems, unpredictable challenges, and in-game status hierarchies.

These features are particularly appealing to players seeking social connection, achievement, or escape. Massively multiplayer online games, for instance, allow players to form lasting bonds in persistent virtual worlds—potentially fulfilling unmet social or emotional needs.

Monetisation Techniques and Behavioural Manipulation

The review also emphasises the increasing role of monetisation strategies in fuelling disordered gaming. Practices like:

  • Loot boxes (randomised reward systems),
  • Microtransactions (buying cosmetic or performance-enhancing content),
  • Personalised pricing and limited-time offers can manipulate psychological vulnerabilities—particularly impulsivity and the sunk-cost effect.

These monetisation models have been compared to gambling mechanisms, and some evidence suggests they disproportionately affect players with existing mental health issues. Vulnerable users (so-called “whales”) may spend significant sums chasing in-game rewards, often to the detriment of their well-being.

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Image from Nicolas Quiñenao at Pixabay

(continues in part 2)

References

Király, O., Koncz, P., Griffiths, M. D., & Demetrovics, Z. (2023). Gaming disorder: A summary of its characteristics and aetiology. Comprehensive Psychiatry, 122, 152376. https://doi.org/10.1016/j.comppsych.2023.152376