The therapeutic challenges presented by compulsive computer use are tremendous. Recognition and treatment are both difficult. Patients downplay their computer use. It is either a topic of shame or a valued asset, a prize not to be put at risk. Thus, it is usually the practitioner that needs to raise the issue. But most mental-health providers became therapists because they like people, not technology. They tend to be low-tech, puzzled by computers. Nor is there any formal curriculum or educational teaching about PCU. So, at the outset, there are significant barriers to recognising and conceptualising the issue. In addition, coexisting psychiatric illnesses are the rule, not the exception. As a result, the therapist will readily find the concomitant diagnoses without realising there is the compounding issue of pathological computer use. The PCU will then complicate and delay the patient’s recovery.

But even for those therapists who actively look for it, the disorder is a difficult one to address. Each virtual world has its own norms and peculiarities, and trying to discuss a virtual world you are unfamiliar with is like doing therapy in an unfamiliar language.

A few years ago, I wrote a paper defining to other therapists what, exactly, was meant by the term “virtual sex”. Recently, to my surprise, I was told that my description was antiquated and only applied to “old-timers”. In my paper, I had described virtual sex as, typically, a form of interactive erotica where two people write sexually explicit messages back and forth. But now I was told of the modern version: people bring their avatars into virtual villas that they own. There, they may walk to a nicely decorated bedroom. In addition to sidetables, lamps and paintings, there is probably a TV, DVD and bed. The virtual TV and DVD are then activated to play a real-life porn film, while the two (or more) avatars climb on to the virtual bed. The bed takes control of them, making them graphically participate in a selection of some 50 sexual positions, along with appropriately evocative vocalisations. The real people presumably masturbate while watching and listening to their avatars have sex in front of the porn flick. The virtual clothing, real estate, home furnishings, TV, porn film, bed and customisable genitalia are all sold online. Fetishes, such as operating a dungeon where one chains up and tortures one’s virtual sexual partner, are also accommodated.