Gaming and internet addiction — ICD-11, CBT, and comorbidity (MEQ)

(i) Diagnosis framing. He shows impaired control, prioritisation of gaming over education/sleep, and continuation despite academic and family harm with clear functional impairment — consistent with ICD-11 gaming disorder (usually ≥12 months; shorter if severe and fully met). State that DSM-5-TR IGD is Section III research language proposing ≥5 of 9 criteria over 12 months — not a fully listed main-text addictive disorder like gambling. Hours alone do not diagnose; impairment does. Loot-box spend adds gambling-adjacent harm.^[1][2]

(ii) Assessment priorities. Structured suicide risk and safety plan after family conflict; domestic violence risk when limits are set; school safeguarding; collateral from parents; ADHD full assessment; mood (major depression vs demoralisation); sleep and substances; online safety; capacity for collaborative limits. Differentials: high engagement without impairment (not this case), primary depression escape, mania (timeline), ASD special interest co-occurrence.^[1]

(iii) Psychosocial first-line plan. Specialised CBT for gaming (cognitive restructuring of rank/obligation beliefs, urge surfing, stimulus control, behavioural activation, sleep scheduling, relapse plans around new releases) with family contingency/MI and school re-engagement. Harm reduction: negotiated time windows, device location, microtransaction controls, not pure confiscation. Measurement and early review. STICA/CBT evidence anchors psychosocial primacy.^[3][4]

(iv) Pharmacotherapy counselling. No tablet is a licensed pure-GD cure. Bupropion has research/comorbidity evidence (craving reduction; improved problematic play in MDD samples) and may be considered when depression (or other licensed indications) coexists, with standard adult dosing frameworks (e.g. SR titration toward 150–300 mg oral daily), seizure-risk counselling, BP/mood monitoring — always with CBT/family care, not instead of it. Treat ADHD on its own evidence base if confirmed.^[5][6]

(v) Pitfalls. (1) Device confiscation alone escalating violence/secrecy without a plan. (2) Claiming a magic licensed anti-gaming tablet or ignoring ADHD/depression while only counting hours.^[1][3]