The second criterion is the concept of tolerance – the need to spend more time or money on the computer in order to feel satisfied. While the average gamer buys about two games every three months, heavy gamers need more. They buy around 13 games and upgrade their systems to use newer technology. The third criterion is that one’s mood be notably altered when using the computer. Often, the user may feel more alive or relaxed when using. When access is limited, however, they may become enraged or depressed. The final criterion is perhaps the most important: the computer use must produce significant problems. Someone – the patient, his wife, a boss, etc – has to be complaining loudly.

Most patients are forced into therapy by their circumstances and have a limited desire to address their computer use. While they may agree it causes problems, rarely do they want to stop. Indeed, the topic of limiting computer time will usually trigger anger. Rather, patients want the therapist to address “real-life” problems. I’ve seen people who have dropped out of school, lost marriages or become recluses because of their computer use. They want the real-life problem fixed but do not want to address the cause.

Compulsive computer users usually request afternoon appointments and come to sessions looking tired. Many wake up to come to therapy after a gaming binge of 10 to 14 hours. In some ways, this is to be expected and is a by-product of how games are designed. In order to reach the challenging levels of most online games players must join clubs, sometimes known as guilds. Since guilds generally meet at night, that is when pathological users start their day. If guild members live in different time zones, the patient might keep pace with the other members’ clocks – a 3am bedtime for one guildmate might be a 6am bedtime for another. As a result, heavy-use gamers often go to bed in the early morning and then wake at midday. If they have morning obligations, they just sleep less and develop chronic sleep deficit.