Psychiatry: disorder groups
Gambling, gaming & behavioural addictions
Behavioural addictions are patterns such as gambling and gaming that become uncontrolled and harmful in the same way as drug addiction. ICD-11 recognises gambling disorder and gaming disorder; psychiatrists assess them, treat them and manage related debt, family and mental health problems.
Depth by stage, Pre-U → Consultant (details)
What is it?
Some behaviours that give pleasure or excitement can become uncontrollable. In gambling disorder, a person keeps gambling despite mounting losses, debt, lies to family and stress. In gaming disorder, which ICD-11 recognised for the first time, online or offline gaming takes priority over study, work, sleep and relationships for at least a year (shorter if severe).
Other problem behaviours such as compulsive shopping, pornography use or social media overuse are discussed in research, and ICD-11 includes compulsive sexual behaviour disorder in the impulse control group, but most are not separate diagnoses.
Young people with heavy online gaming and adults with online gambling or illegal betting are increasingly seen in Malaysian clinics. Legal gambling in Malaysia is restricted to non-Muslims, which affects how people seek help.
Why does a psychiatrist need it?
Psychiatrists need to recognise behavioural addictions behind presentations such as depression, suicide attempts after debts, or adolescents refusing school. They should distinguish harmful from heavy but healthy use, treat comorbid ADHD, depression and anxiety, and use motivational and CBT-based approaches with families.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalAwareAware that gambling and gaming can be disorders.
- HousemanshipAwareRecognises problem gambling or gaming behind presentations like self-harm or debt.
- Medical officerUnderstandsScreens and gives brief interventions, referring complex cases.
- Psych traineeAppliesAssesses and treats gambling and gaming disorder alongside comorbid conditions.
- Specialist / consultantAppliesManages complex cases; addiction subspecialists lead services.
What are the key topics?
Conditions
- Gambling disorder (ICD-11 and DSM-5-TR)
- Gaming disorder (ICD-11); 'internet gaming disorder' as a condition for further study in DSM-5-TR
- Compulsive sexual behaviour disorder (ICD-11, impulse control group)
- Other impulse control disorders: kleptomania, pyromania, intermittent explosive disorder
- Problematic smartphone and social media use (research concept)
Mechanisms
- Reward circuits and intermittent reinforcement
- Cognitive distortions in gambling (illusion of control, chasing losses)
- Game and app design features that promote prolonged use
- Comorbid ADHD, depression, anxiety, substance use
Assessment and treatment
- Screening tools such as the Problem Gambling Severity Index
- Family history, financial and legal consequences, suicide risk
- CBT, motivational interviewing, relapse prevention
- Family involvement, especially for adolescents
- Practical measures: self-exclusion, financial controls, screen-time limits
- Support groups and online help
How is it learned and assessed?
- Undergraduate psychiatry teaching on addiction
- Addiction and child psychiatry rotations in training
- MMed Part II; MRCPsych Paper B (clinical topics)
Typical textbooks and resources
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- Motivational Interviewing: Helping People Change — Miller & Rollnick, Guilford Press
- WHO information on gaming disorder — World Health Organization
- Kaplan & Sadock's Synopsis of Psychiatry — Wolters Kluwer
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Is playing video games a lot the same as gaming disorder?
No. Gaming disorder requires loss of control, gaming taking priority over other life activities, and continued gaming despite harm, usually for at least a year. Many heavy gamers do not have the disorder.
Can gambling disorder be treated?
Yes. CBT, motivational approaches, family support and practical steps such as blocking access to gambling and money management help many people recover.