Why do adults seek treatment for gaming (disorder)? A qualitative study

The study addresses why adults seek treatment for issues related to their videogame play, a question that remains largely unanswered despite the ICD-11’s inclusion of gaming disorder. Prior diagnostic descriptions note impairment in personal, social, educational, or occupational functioning, but it is unclear whether such impairments are the same as those prompting treatment-seeking. The authors aim to qualitatively map and understand adult treatment-seekers’ reasons using a unique clinical dataset from Finland, focusing on participants’ own accounts of problems and expectations.

Prior research has attempted to classify problematic gaming using cluster analyses, latent class analyses, and theory-driven typologies, often to distinguish clinical from non-clinical populations. However, few studies include treatment-seeking samples, and virtually none align participants with official gaming disorder diagnoses (ICD-11) due to their recent adoption. Evidence suggests external pressures (e.g., parents, family, authorities) strongly drive treatment-seeking among youths, with limited insight into internal motivations. Large clinical studies (e.g., South Korea) have reported family pressure and advice from friends as common drivers, and some countries’ screening programs can lead to treatment via authoritarian recommendations. Adult-specific reasons for treatment-seeking remain unmapped, motivating the present study to focus explicitly on adult applicants’ subjective motivations and contexts.

Design: Preregistered qualitative study using template analysis. Data source: Applications to the Finnish government-funded remote treatment program “Restart” (a Peluuri subservice) for videogame-related problems, collected 2020–2022. Permissions were obtained (01/31/2022); ethics review was deemed unnecessary per Finnish guidelines due to use of existing data without personal identifiers. Sample: N = 110 adults (91 men, 83%; 3 undisclosed), mean age 30.5 (SD = 6.8). Relationship status: 55% in a romantic relationship; 37% lived alone. Recruitment: 51% found the program independently; 33% referred from other services; 15% applied due to recommendation by friends/family. Measures and data: Three open-ended application items analyzed—(1) reasons for applying, (2) expectations regarding the program, and (3) support needed. Additional descriptive items: length, type, and self-assessment of gaming problems; Internet Gaming Disorder Test-10 (IGDT-10; Finnish translation) completed by n = 89 who started treatment. Coding and analysis: Template analysis (Brooks et al., 2015) tailored to generate a multilevel thematic structure. One author developed coding instructions after reading all data; two authors independently coded using the instructions (one in Finnish to capture local nuances). Team meetings reconciled high-level themes. The non-coding author iterated micro-level hierarchies to produce a draft template, followed by team negotiation of the final template. Positionality: Coders were mental health professionals (psychologist; treatment expert with experience in gambling/gaming help); the non-coding author is a senior researcher in gaming disorder and qualitative methods. Reliability and additional analyses: IGDT-10 reliability among treatment starters: omega = 0.86. A para-exploratory deductive coding round assigned up to two of the discovered themes to each case among those with IGDT-10 data (n = 89); inter-coder agreement: 98% on primary theme, 69% on both primary and secondary themes. The study’s preregistration is available (OSF), and code/coding materials are provided in supplements.

• Duration and prevalence of problems: Mean length of gaming-related problems was 8.7 years (SD = 6.5). Of those responding (n = 105), self-indicated problems were: time spent on gaming 94 (90%), impact on social relationships 80 (76%), studies/work 71 (68%), money spent on gaming 32 (30%). Four applicants (4%) did not consider their gaming problematic in a binary item; two applied to comply with others’ wishes; one reported past problems; one discussed problems despite indicating “no problems.”
• Games implicated: Numerous titles across genres and platforms were cited; 26 were mentioned more than once. Most frequent mentions included League of Legends (14), World of Warcraft (13), Counter-Strike (13), Dota 2 (11), Call of Duty (10), RuneScape (6), Path of Exile (6), Guild Wars 2 (5), Apex Legends (5), Overwatch (5), and several others (e.g., Cyberpunk 2077, Dark Souls, Fortnite). A group labeled “gambling-like titles” (15) involved gaming with money/casino simulations though the program was not for gambling; these individuals also named other videogames.
• IGDT-10: Among treatment starters (n = 89), omega = 0.86; mean score 3.86 (SD = 2.55), below the cutoff 5.00. A total of 37 (42%) met the cutoff.
• Main thematic reasons (template analysis): Five themes captured reasons for seeking treatment: (1) Social reasons (complying with others’ requests vs. intrinsic desire to improve social life/roles as partner/parent); (2) Existential reasons (loss of meaning in gaming/life; desire to find other interests, motivation, re-evaluate priorities and values); (3) Practical reasons (ameliorate performance harms in education/work/routines; health harms including anxiety and sleep problems; financial harms from spending in games); (4) Self-perceived addiction (wish to control/reduce/quit gaming; recognition of urges, relapse, time-use problems; gaming as avoidance/escape); (5) Wish for support (seeking guidance, skills, practical tools, accountability; desire for empathic listening, individual therapy, or peer support).
• Cross-cutting meta-theme: Time prioritization, regulation, and loss of time recurred across themes (e.g., “gaming just takes too much of my time”).
• Para-exploratory thematic distribution by IGDT cutoff (n = 89): Primary/secondary theme coding suggested small group differences except one: sub-cutoff individuals more often sought help for practical reasons (28%) than cutoff group (14%). Self-perceived addiction and wish for support were common in both groups (overall 45% and 47%, respectively).

The findings demonstrate that adults seek treatment for a wide array of gaming-related problems, extending beyond the ICD-11 gaming disorder description. While some treatment-seekers describe impairments consistent with diagnostic criteria (e.g., educational/occupational harms), other reasons—such as financial harms and loss of meaning—are not covered by ICD-11. The relatively low average IGDT-10 score, with only 42% meeting the cutoff, suggests many help-seekers experience significant difficulties without meeting screening thresholds, raising questions about what IGDT-based constructs capture and the emphasis of DSM-5/IGDT-10 on dependence-like symptoms over practical harms. The diversity of implicated games indicates that problematic engagement spans numerous genres and monetization models, with many titles featuring competitive and free-to-play designs; the presence of gambling-like game elements highlights the importance of examining monetization (e.g., loot boxes) and financial consequences. A prominent need among participants was for support, empathy, and opportunities to discuss gaming problems—indicating possible stigma or taboo around discussing such issues in the Finnish context. Clinically, the results support an expanded approach to care: not all gaming-related problems should be medicalized as mental disorders, but individuals with intensive gaming may benefit from tailored psychosocial support addressing comorbidity (e.g., anxiety), time management, financial behaviors, and social functioning. The para-exploratory observation that sub-cutoff individuals more often report practical harms suggests current screening tools may underweight salient treatment-seeking drivers, warranting future confirmatory studies and potentially revised assessment practices.

This study is the first to focus specifically on adult gamers’ treatment-seeking experiences using their own accounts. Template analysis of 110 adult applicants identified five main themes—social reasons, existential reasons, practical reasons, self-perceived addiction, and wish for support—comprising 11 sub-reasons and 29 specific expectations. Adults seek help for many types of games and diverse problems, including issues not encompassed by current gaming disorder criteria. The authors recommend researchers and practitioners adopt a broadened perspective on problematic gaming, decoupling all treatment-seeking from psychiatric diagnosis where appropriate and providing varied support options. Future research should: (1) confirm thematic differences between screening cutoff groups, especially regarding practical harms; (2) examine relationships between specific game types/features and reasons for treatment-seeking; (3) incorporate clinical diagnostic interviews to benchmark against screening tools; and (4) investigate sociocultural factors, stigma, and communication needs that shape help-seeking.

The dataset lacked clinical diagnoses, preventing gold-standard determination of gaming disorder or other mental disorders among participants. Open-ended survey responses are less rich than researcher-coproduced interview data, limiting depth of analysis. The wording of the third open item (“What kind of aid do you need?”) likely increased the proportion of content related to support needs, potentially inflating the presence of the “wish for support” theme; however, the descriptive template approach mitigates quantitative bias by focusing on types of support rather than frequencies.