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Background There are no standard diagnostic criteria or interventions for internet gaming addiction (IGA) even though IGA is one of the most pervasive public health issues among youth worldwide. Internet gaming reasons or motivations have been studied as a potential predictor of IGA, but the results have been inconsistent and biological indicators of gaming reasons have rarely been studied. We sought to (1) identify categories of internet gaming reasons, (2) examine the relationship of gaming reasons to risk of IGA, and (3) describe biological indicators associated with reasons for gaming. Methods We used a multi-phase cross-sectional design including individual interviews; focus group discussion; and descriptive, comparative analysis. Fifteen Korean adolescent male internet gamers participated in individual interviews and eight participated in a focus group aimed at identifying reasons for internet gaming. Using the identified gaming reasons from these sources we surveyed 225 adolescent game users using a self-report questionnaire. Participants provided blood samples for assessment of norepinephrine (NE) and serum cortisol. Results We identified four major categories of internet gaming reasons: entertainment, getting along with friends, stress relief, and habitual gaming. The habitual group showed significantly greater risk of IGA than the other groups (p p = .035), possibly indicating an alteration in autonomic function. Conclusion Health care providers are encouraged to screen adolescents for excessive internet gaming and to intervene with those who report habitual gaming behaviors. When feasible, assessment of biological indicators, such as plasma NE, may help to identify youth at greatest risk of IGA.

Background The number of people with Internet gaming addiction (IGA) is increasing around the world. IGA is known to be associated with personal characteristics, psychosocial factors, and physiological factors. However, few studies have examined the genetic factors related to IGA. This study aimed to investigate the association between IGA and stress-related genetic variants. Methods This cross-sectional study was conducted with 230 male high school students in a South Korean city. We selected five stress-related candidate genes: DAT1, DRD4, NET8, CHRNA4, and CRHR1. The DAT1 and DRD4 genes were genotyped by polymerase chain reaction, and the NET8, CHRNA4, and CRHR1 genes were genotyped by pyrosequencing analysis. We performed a Chi-square test to examine the relationship of these five candidate genes to IGA. Results Having the AA genotype and the A allele of the CRHR1 gene (rs28364027) was associated with higher odds of belonging to the IGA participant group (p = .016 and p = .021, respectively) than to the non-IGA group. By contrast, the DAT1, DRD4, NET8, and CHRNA4 gene polymorphisms showed no significant difference between the IGA group and control group. Conclusions These results indicate that polymorphism of the CRHR1 gene may play an important role in IGA susceptibility in the Korean adolescent male population. These findings provide a justification and foundation for further investigation of genetic factors related to IGA.