Severe functional impairment secondary to internet gaming disorder: a case presentation

Background. Pathology related to internet use is a growing concern in psychiatry. Internet gaming disorder (IGD), as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, text revision (DSM-5-TR), can lead to severe functional impairment and a decreased quality of life. Objectives. To present a case of severe internet gaming disorder comorbid with narcissistic personality disorder, highlighting the profound bio-psycho-social functional impairment and the complex family system dynamics involved. Material and methods. We present the clinical case of a 25-year-old male, including anamnesis, psychiatric examination based on DSM-5-TR criteria, differential diagnosis, and a review of the proposed therapeutic management. Outcomes. The patient met all nine DSM-5-TR criteria for severe IGD and the diagnostic criteria for narcissistic personality disorder. The addiction resulted in an extreme functional decline, including a complete loss of autonomy in self-care, educational and professional failure, and the enmeshment of his mother in the addictive cycle. The patient refused the proposed combined pharmacological and psychotherapeutic treatment. Conclusions. This case illustrates the devastating multi-level impact of severe IGD, particularly when co-occurring with a personality disorder. It underscores the critical role of family systems in the pathology and highlights the need for further research into the interplay between narcissism, family dynamics, and addictive behaviors.